Prior Authorization Technician

The Prior Authorization Technician shall be responsible for the authorization process of orders coming into the Pharmacy from AON clinics.

KPA 1 – Prior and REMS Authorizations

Submit prior authorizations on behalf of physicians

Follow up on submitted PA requests when no response is received

Monitor each PA through the process until approved/denied, and inform patient, staff and clinic as indicated.

Responsible for assisting the clinicians in obtaining Celgene authorization and confirmation numbers.

KPA 2 – Appeals

Will review and initiate prior authorization appeal services to include first level appeal reviews. Will coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required.

KPA 3 – Backup to pharmacy staff

Will monitor daily activities and provide backup support where needed, including PAP, SP follow-ups, BV and claims adjudication as needed.

KPA 4 – Education & Training

Responsible for keeping up on all applicable training and education for maintenance of permit.

Will train staff on PA processes.

KPA 5 – Customer Service

Incoming and outgoing calls/emails to patients. Routing of calls to appropriate staff. Answering patient/clinic questions regarding delivery status, Rx updates, etc.

SP follow-up to assure orders are being processed efficiently.

Scheduling deliveries.

Education

High school diploma, GED or equivalent education is required

Minimum Relevant Experience

Minimum of two years’ experience in Retail/Specialty/Hospital Pharmacy as a Pharmacy Technician preferred; medical terminology and attention to detail required.

Certifications/Licenses

Pharmacy technician registration with the Florida Dept of Health in good standing required.

Valid state Driver’s License for travel to satellite offices and offsite meetings. Compliance with the company Driver Safety Operations and Motor Vehicle Records Check Policy is required.

Travel: 0%

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