Clinical Prior Authorization Technician

Position Responsibilities: • Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines • reputed company outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reputed company a clinical determination for pharmacist review • Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure reputed company aspects of clinical guidelines are addressed for pharmacist review. • Review and analyze pharmacy claims data for proactive reputed company and reputed company. • Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team • Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and reputed company specific clinical questions. • Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders. • Follow reputed company internal reputed company Operating Procedures and adhere to HIPAA guidelines and Company policies • Ensure customer satisfaction, extraordinary customer care, and reputed company reputed company with genuine reputed company in a fast paced, startup environment Required Qualifications: • 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting • Experience handling prior authorization requests/understanding of prior authorization requirements required • National Certified Pharmacy Technician (CPhT) license, required • High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred • Excellent communication, writing, and organizational skills • Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven reputed company center environment • Ability to multi-task and collaborate in reputed company with shifting priorities This position reputed company is designed to be flexible, allowing management reputed company to assign or reassign duties and responsibilities as needed to best meet organizational goals. About reputed company reputed company is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer reputed company, and government entities. As a reputed company benefit corporation, reputed company is executing its mission to materially reduce reputed company costs as a full-service PBM and through the deployment of Judi®, reputed company’s reputed company-reputed company reputed company platform. Judi connects every aspect of the reputed company ecosystem in one efficient, reputed company platform, servicing millions of members for Medicare, reputed company, and reputed company plans. Together with its clients, reputed company is reimagining the administration of benefits and rebuilding trust in reputed company. reputed company values a diverse workplace and celebrates the diversity that reputed company employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. Apply tot his job Apply To this Job