Pharmacy Authorization Specialist (Pharmacy Technician)

UHS•Reno, NV

61d

About The Position

The Pharmacy Authorization Specialist (Pharmacy Technician) serves as the coordinator between Prominence Health Plan, its members and contracted providers for the prior authorization review process. The main focus of this position is preparing and loading prior authorizations for injectable drugs. This includes ensuring proper diagnosis and billing codes are input and verifying the accuracy of the dose and frequency of submitted requests. In addition, this individual will perform provider outreach to obtain sufficient documentation for coverage determinations as necessary. We are looking for someone with an understanding of medical drug billing and a background that includes interpreting clinic notes and/or drug orders. By performing these duties, the Pharmacy Authorization Specialist will coordinate an effective and efficient review process, improving the internal workflow of the pharmacy team and increasing member and provider satisfaction with our prior authorization review process.

Requirements

High School diploma or equivalent
Current and valid state licensure as a pharmacy technician is required
3+ years in hospital or retail pharmacy is preferred
Ability to effectively communicate in English, both verbally and in writing.
Knowledge of medical terminology
Exceptional customer service skills, interfacing between the health plan and providers’ offices
Understanding of the medical drug billing process
Proficient in Microsoft Office
Enjoys working in both individual and team settings
Comfortable calculating doses and frequencies for medication treatment regimens
Self-starter, resourceful and able to execute projects in a fluid and fast paced environment
Strong analytical skills
Knowledge of the purpose and process of prior authorizations
Attention to detail and accuracy
Ability to utilize technology and work within multiple software programs
Understanding of health plan departments and functional areas for problem resolution
Comfortable collecting and tracking performance metrics and reports

Responsibilities

Preparing and loading prior authorizations for injectable drugs.
Ensuring proper diagnosis and billing codes are input.
Verifying the accuracy of the dose and frequency of submitted requests.
Performing provider outreach to obtain sufficient documentation for coverage determinations as necessary.
Coordinating an effective and efficient review process.
Improving the internal workflow of the pharmacy team.
Increasing member and provider satisfaction with our prior authorization review process.