Prior Authorization Technician

American Oncology Network•Fort Myers, FL

11h•Hybrid

About The Position

The technician shall be responsible for the authorization process of orders coming into the Pharmacy from clinics. This role involves managing prior authorizations and REMS authorizations, including submitting requests, following up on their status, and communicating approvals or denials to patients, staff, and clinics. The technician will also assist clinicians in obtaining specific authorization and confirmation numbers. Additionally, the role includes reviewing and initiating prior authorization appeal services, coordinating appeal reviews, and potentially participating in peer-to-peer interviews. The technician will provide backup support to other pharmacy staff, including tasks related to PAP, SP follow-ups, BV, and claims adjudication. A key part of the role is staying current with applicable training and educating staff on PA processes. Excellent customer service is expected, involving incoming and outgoing calls/emails to patients, routing calls, answering questions about delivery status and Rx updates, and ensuring efficient order processing through SP follow-up and scheduling deliveries.

Requirements

High school diploma, GED or equivalent education
Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred
Medical terminology required
Attention to detail required
Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills
Detailed oriented with the ability to exercise independent judgment
Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness
Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters
Effective communication skills (oral, written, presentation)
Active listener
Effectively provides balanced feedback
Strong customer focus
Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations
Effectively manages own time, conflicting priorities, self, stress, and professional development
Self-motivated and self-starter with ability work independently with limited supervision
Ability to work remotely effectively as required
Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites
Proficiency in MS Office Word, Excel, Power Point, and Outlook required
Pharmacy technician registration with the Florida Dept of Health in good standing required
Valid state Driver’s License for travel to satellite offices and offsite meetings
Compliance with the company Driver Safety Operations and Motor Vehicle Records Check Policy is required

Nice To Haves

Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician

Responsibilities

Submit prior authorizations on behalf of physicians
Follow up on submitted PA requests when no response is received
Monitor each PA through the process until approved/denied, and inform patient, staff and clinic as indicated
Assist the clinicians in obtaining Celgene authorization and confirmation numbers
Review and initiate prior authorization appeal services to include first level appeal reviews
Coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required
Monitor daily activities and provide backup support where needed, including PAP, SP follow-ups, BV and claims adjudication as needed
Keep up on all applicable training and education for maintenance of permit
Train staff on PA processes
Handle incoming and outgoing calls/emails to patients
Route calls to appropriate staff
Answer patient/clinic questions regarding delivery status, Rx updates, etc.
Perform SP follow-up to assure orders are being processed efficiently
Schedule deliveries