What are the responsibilities and job description for the Prior Authorization Review Technician position at MetroPlusHealth?
Position Overview
The Prior Authorization Review Technician is responsible for inputting, providing notification for and reviewing prior authorization requests. The Prior Authorization Review Technician is also responsible for entering and auditing overrides input in the Pharmacy Adjudication system, answering member inquiries and assisting in all relevant Pharmacy department deliverables.
Job Description
- Inputs all received medical benefit and pharmacy benefit prior authorization requests into our processing platforms, ensuring accurate transcription of all information
- Reviews and provides recommendations for select prior authorization requests following internal guidelines and criteria for review
- Answer inquiries from, but not limited to, members, providers and pharmacies received from our pharmacy call center line
- Provides verbal notification of prior authorization decision and inputs accurate medication overrides in the pharmacy adjudication platform
- Performs audit of vendor-inputted medication overrides in the pharmacy adjudication platform
- Assists in pharmacy case management activities
- Supports departmental quality initiatives
- Answers all triaged inquiries regarding MetroPlus Health Pharmacy and Medical Benefit
Minimum Qualifications
Licensure and / or Certification Required :
Professional Competencies :
Salary : $53,830
