Pharmacy Technician

Actalent•Wilmington, DE

37d•$18 - $20•Remote

About The Position

We are seeking a dedicated Pharmacy Technician - Prior Authorization Specialist to join our team. This role involves managing coverage determination requests and facilitating communication between providers, pharmacists, and members. You will play a crucial role in ensuring that authorizations are processed efficiently and accurately.

Requirements

Prior authorization experience.
Data entry proficiency.
Pharmacy experience.
Customer service skills.
Pharmacy technician license.
Proficient computer skills.

Nice To Haves

Experience with Microsoft applications.
Managed care knowledge.
Familiarity with Medicare/Medicaid.
Experience with remote work setups.

Responsibilities

Track and triage coverage determination requests submitted by providers.
Determine if a pharmacist review is required for submitted requests.
Obtain verbal authorizations and request detailed clinical information from prescribers.
Approve coverage determination requests based on defined criteria.
Enter and document coverage determination request decisions into the PBM system.
Notify providers and/or members of decision outcomes.
Respond to client inquiries regarding authorization approvals and PBM online applications.
Refer coverage determination requests for specialty drugs to delegated vendors or clients for processing.
Contact providers for additional information to facilitate coverage determination reviews.
Notify physicians, providers, and members of coverage determination request decisions.