Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Prior Authorization Rep
The Associate Clinical Operations Technician is responsible for processing, communicating, documenting and tracking requests for formulary exceptions, prior authorizations, quantity exceptions, and brand override for delegated utilization management (UM) products and services.
Review criteria to determine if the request can be approved
Accurately enter Prior Authorization in claims system to ensure appropriate claims will adjudicate
Respond to completed requests by creating written communication of the clinical outcome to the member and the member's physician within client specific turnaround times
Research and respond to calls and emails
Perform outreach to pharmacies and physician's offices related to the department process across multiple clients to obtain all necessary information related to UM requests, including occasional member assistance
Provide all relevant clinical information specific to a UM request to a department Pharmacist and the Physician
Manage work queue and volumes to meet client specific turnaround times
Other duties as assigned
Commercial: Responsible to be proficient in one area (i.e., intake, research, etc.); area assignment is based on department need
Government Programs: Responsible to be proficient in single review, approval/denial, etc.
High school diploma from an accredited school or equivalent GED
Must be eligible to work in the United States without need for work visa or residency sponsorship
Strong verbal and written communication skills, interpersonal skills, and attention to detail
Demonstrated organizational and time-management skills
Willingness and ability to learn internal systems/processes/programs as needed
Ability to work overtime, weekends and holidays on a rotating basis as needed
Basic math skills and general PC knowledge including Microsoft Office, Internet, and email.
Ability to work a flexible schedule to accommodate business needs
Associate's degree in business or related area of study, or equivalent combination of education and/or relevant work experience
National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
PBM/health care experience
Minimum Physical Job Requirements
Constantly required to sit, use hands to handle or feel, talk and hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and crouch
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions.
Prime Therapeutics LLC