Pharmacy Prior Authorization Representative - Remote CT

Gainwell Technologies LLC

2d•Remote

About The Position

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. SummaryThe Pharmacy Prior Authorization Call Center (PPAAC) Representative supports the Connecticut Medicaid account in a fast-paced, high-volume call center environment. This role is responsible for answering and resolving inquiries from prescribers and pharmacies related to pharmacy claims and prior authorization requests, ensuring timely, accurate, and compliant processing. Working as part of a small, specialized team, the PPAAC Representative is required to process all pharmacy prior authorizations within 24 hours of receipt. This position requires flexibility to work rotating shifts, including second and third shifts, as well as on-call coverage on a rotational basis. Other duties may be assigned as needed.Your role in our mission

Requirements

Knowledge of pharmacy claims processing and pharmacy dispensing systems, with exposure to Medicaid and/or Medicare Part D programs
Ability to work effectively in a high-paced, high-volume environment with strong multi-tasking and time management skills
Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience working in a paperless, technology-driven environment
Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams
Active Connecticut Pharmacy Technician license, along with prior retail pharmacy or customer service experience

Responsibilities

Serve as a primary point of contact for prescribers and pharmacies regarding pharmacy claims and prior authorization inquiries
Analyze pharmacy claims and provide accurate clarification, verification, and resolution to provider inquiries
Process prior authorization requests, including approvals and denials, and document rationale in accordance with policy
Accurately document all call interactions, inquiries, decisions, and resolutions in the system
Maintain confidentiality and compliance with HIPAA and Connecticut Medicaid guidelines