Summary:
The primary purpose of the job is to: Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician I assists in the prior authorization process.

Responsibilities:

• Responsible for reviewing and approving physician or member inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.
• Responsible for accurate and timely data entry of prior authorization requests within the Prior authorization system to meet all client specific requirements and contractual agreements.
• Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner.
• Responsible for receiving prior authorization requests telephonically while utilizing multiple systems to confirm accuracy of the information being provided.
• Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered.
• Recommends course of action for providers where patterns appears outside of guidelines and generally accepted pharmacy standards.
• Maintains a balance of productivity, quality and timeliness of job accountabilities.
• Participates in department self-audit procedures for on-going evaluation of service.
• Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.
• Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.
• Compliance with HIPAA regulations and AMFC policies and procedures.
• bility to adapt to a high pace changing environment.
• Strong interpersonal, written and oral communication skills.
• ttention to detail and ability to follow instructions.
• ttends required training on an annual basis.
• Strong knowledge in specialty and non-specialty pharmaceuticals
• Performs other related duties as assigned.

Preferred Skills:

• one to three years
• Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
• Minimum 35 words per minute typing speed. Current PTCB or NCCT Certificate Preferred