Prior Authorization Technician I
Company: Amerihealth Caritas Health Plan
Posted on: June 12, 2021
PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to
clinical culture, boutique service and holistic solutions. Our
mission is to help customers, doctors and patients use effective
medication therapy to improve health and wellness. For more than 15
years, our focus has been on providing optimal service through a
clinical culture which seeks to provide members with high quality
care while ensuring our partners receive favorable costs. That
culture is reflected in our employees; more than 80 percent of our
staff members are Pharmacists and Pharmacy Technicians, and in the
services we provide.
PerformRx is headquartered in Philadelphia. Our dedication to
innovation and to providing the most efficacious outcomes is the
core of our clinical culture and is the heart of PerformRx.
PerformRx is a subsidiary of the AmeriHealth Caritas Family of
- Candidates must reside in North Carolina. *
Under the general supervision of the Supervisor of Pharmacy
Prior Authorization Technicians, the Prior Authorization Technician
I assists in the prior authorization process.
- Responsible for understanding and applying clinical criteria
for processing Prior Authorization requests in a timely manner for
pharmacy and medical billing. Responsible for making outbound
calls/receiving inbound calls, speaking with physicians' offices
for additional information or clarifications needed to process
prior authorization request.
- Supports the 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.
- Keeps abreast of industry trends and regulatory changes in the
pharmacy industry and incorporates knowledge in the performance of
job duties. Identifies problems in process/procedures or services
and makes recommendations for improvements. Maintains a balance of
productivity, quality and timeliness of job accountabilities.
Participates in department self-audit procedures for on-going
evaluation of service.
- Maintains and updates internal databases. Enters application
information, prior authorizations and other relevant data. Ensures
database information and appended files are current and accessible
to staff. Generates reports and other information requested on a
scheduled/as needed basis.
- 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.
- Performs other related duties as assigned
- Attends required training on an annual basis
- Adheres to AMFC policies and procedures
- Must be available to work weekends and holidays. *
7:00 a.m. to 3:30 p.m.
8:30 a.m. to 5:00 p.m.
9:30 a.m. to 6:00 p.m.
10:30 a.m. to 7:00 p.m.
12:30 p.m. to 9:00 p.m.
- High School Diploma or equivalent required
- Must be currently registered with the North Carolina Board of
- Active/current National Pharmacy Technician Certification
(i.e., ExCPT, NCCT, PTCB) required
- Current/recent Pharmacy Benefit Manager (PBM), managed care,
hospital pharmacy, long-term care (LTC) pharmacy, home infusion
pharmacy, and/or retail pharmacy experience preferred
- Knowledge in pharmacy practices, procedures and precedents;
ability to read and understand pharmaceutical information
- Working knowledge of drug dosage forms, drug strength, generic
& trade name equivalent
- Demonstrates knowledge of Federal & State laws/regulations
regarding provisions of pharmaceutical services
- Strong knowledge in specialty pharmaceuticals
- Ability to multi-task and prioritize work
- Ability to comprehend and follow established office routines,
policies and procedures
- Customer service and interpersonal skills
- Ability to adjust based on business/department needs
- Demonstrated courteous and professional behavior
- Proficient PC skills in a windows based environment
- Ability to identify problems including complex issues and
determine solutions, both independently or in a team/group
- Must be organized, detail-oriented and have excellent
communication skills (listening, verbal, written, grammar)
Keywords: Amerihealth Caritas Health Plan, Raleigh , Prior Authorization Technician I, Other , Raleigh, North Carolina
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