Clinical Prior Authorization Technician - Remote

Overview

The Clinical Prior Authorization Technician plays a crucial role in validating and processing prior authorization requests within a health technology company, ensuring compliance with clinical guidelines and providing exceptional customer service.

In Short

• Prepare prior authorization requests by validating prescriber and member information.
• Make outbound calls to providers for additional clinical information.
• Obtain clinical information from prescribers for pharmacist review.
• Review pharmacy claims data for outreach and intervention.
• Document and escalate provider concerns to the internal team.
• Triage phone calls from members and providers.
• Communicate issues and resolutions effectively.
• Follow internal procedures and adhere to HIPAA guidelines.
• Ensure customer satisfaction in a fast-paced environment.

Requirements

• 2+ years of pharmacy technician experience in a PBM or clinical pharmacy setting.
• Experience with prior authorization requests is required.
• National Certified Pharmacy Technician (CPhT) license is required.
• High school diploma or equivalent; Associate’s or bachelor’s degree preferred.
• Excellent communication, writing, and organizational skills.
• Ability to work independently in a remote environment.
• Ability to multi-task and collaborate with shifting priorities.

Benefits

• Flexible position description to meet organizational goals.
• Diverse workplace with equal employment opportunities.