Pharmacy Prior Authorization Representative - Remote CT
About The Position
The 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.
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
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
