Sr Prescription Benefit Prior Authorization Technician Specialty

Blue Cross Blue Shield of Arizona•Phoenix, AZ

2d•Remote

About The Position

Responsible for internal and external support functions that contribute to accurate claim processing for medications. Processes medication prior authorization requests from providers and answers incoming phone calls related to escalated issues and prior authorization clarifications.

Requirements

High School Diploma or GED
Must obtain and maintain an Arizona State Board Pharmacy Technician license within 9 months of hire.
Must obtain and maintain a Pharmacy Technician Certification Board (PTCB) certification within 9 months of hire.
1 year experience in pharmacy or medical field (Level 1)
2 years experience in pharmacy or medical field (Level 2)
1 year experience in prior authorization intake and processing (Level 2)
3 years experience in pharmacy or medical field (Level 3)
2 years experience in prior authorization intake and processing (Level 3)
1 year experience with specialty pharmacy or medical reviews (Level 3)
10 years experience in pharmacy or medical field (Level 4)
4 years experience in prior authorization intake and processing (Level 4)
2 years experience with specialty pharmacy or medical reviews (Level 4)
Intermediate PC proficiency (word processing, spreadsheets, claims systems)
Ability to build collaborative relationships
Flexibility in prioritizing work
Business communication skills
Residency within the State of Arizona

Nice To Haves

3 years pharmacy benefit or prescription claims experience (Level 1)
1 year prior authorization experience (Level 1)
1 year experience with BCBSAZ PBM system (Level 1)
2 years handling confidential information (Level 1)
3 years pharmacy benefit or prescription claims experience (Level 2)
2 years prior authorization experience (Level 2)
1 year experience with BCBSAZ PBM system (Level 2)
3 years handling confidential information (Level 2)
5 years pharmacy benefit or prescription claims experience (Level 3)
3 years prior authorization experience (Level 3)
2 years experience with BCBSAZ PBM system (Level 3)
1 year experience with medical and pharmacy claims systems (Level 3)
4 years handling confidential information (Level 3)
12 years pharmacy benefit or prescription claims experience (Level 4)
10 years prior authorization experience (Level 4)
3 years experience with BCBSAZ PBM system (Level 4)
2 years experience with medical and pharmacy claims systems (Level 4)
10 years handling confidential information (Level 4)
Advanced PC proficiency
Strong interpersonal communication
Multicultural sensitivity
Pharmacy claims system experience

Responsibilities

Process prior authorization reviews including intake, clarification, approvals, denials, exclusions, and exceptions
Meet standard, urgent, and expedited turnaround times for requests
Respond to internal and external inquiries regarding prior authorization and benefit clarifications
Participate in projects supporting prescription benefit improvements
Support audits, reporting, and quality initiatives
Maintain knowledge of systems, procedures, and guidelines
Meet department production and quality metrics
Work full-time schedule (minimum 40 hours per week)
Perform other duties as assigned
Provide recommendations to pharmacists based on benefit plan design and guidelines
Assist in improving quality and performance standards
Communicate recommendations regarding authorization decisions
Provide recommendations based on pharmacy and medical guidelines
Process specialty medication reviews
Maintain knowledge of pharmacy and medical claims systems
Serve as subject matter expert for specialty prior authorization