Prior Authorization Pharmacy Technician I
Viva Health•Birmingham, AL
•Hybrid
About The Position
The Prior Authorization Pharmacy Technician I will process coverage determinations (prior authorization and exception requests) to the Plan formulary. This role receives, researches, documents, and processes the coverage determinations in a timely manner as required by regulatory requirements. This position also communicates decisions with providers, members, and internal staff as directed by management.
Requirements
- High School Diploma or GED
- Current Pharmacy Technicians License in good standing with the Alabama State Board of Pharmacy
- CPhT (Certified Pharmacy Technician) from the Pharmacy Technician Certification Board or the National Healthcare Association
- Demonstrate excellent customer service skills through written and verbal communication
- Basic computer skills
- Ability to work overtime and share after-hours, holidays, inclement weather, and weekend responsibilities
Nice To Haves
- Bachelor’s Degree or equivalent work experience
- Customer service or call center experience
- Physician office experience
- Health Plan or PBM experience
- Current LPN License in good standing with the State of Alabama Board of Nursing
- Licensed Practical Nurse Certification
Responsibilities
- Receive, review, process, and respond to coverage determinations to the Plan formulary in accordance with departmental guidelines and federal regulations.
- Provide support to internal and external customers and serve as a representative for the department both internally and externally.
- Maintain coverage determination policies and procedures and assist with policy and procedure education for customers.
- Responsibilities may require evening and weekend work as well as overtime in response to Centers for Medicare and Medicaid Services (CMS) requirements.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
101-250 employees
