Prior Authorization Technician - Pharmacy Technician
Company: Capital Rx, Inc
Location: New York
Posted on: September 21, 2023
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Job Description:
Prior Authorization TechnicianLocation: Remote
About Capital Rx
Capital Rx is a next generation pharmacy benefits manager,
overseeing prescription benefit plans on behalf of employers,
unions, and government entities. Determined to transform an
outdated model, Capital Rxs mission is to change the way
prescription benefits are priced and administered in the US,
unlocking enduring social change. Through our platform approach,
Capital Rx delivers data-driven insights and actionable strategies
that reduce costs, while improving patient outcomes. Our commitment
to innovation, technology and service is the reason why Capital Rx
is among the fastest-growing PBMs in the country.
Position Responsibilities:
* Prepare prior authorization requests received by validating
prescriber and member information, level of review, and appropriate
clinical guidelines
* Make outbound calls to providers to obtain additional clinical
information to ensure substantial clinical information exists to
reach a clinical determination for pharmacist review
* Proactively obtains clinical information from prescribers,
referral coordinators, and appropriate staff to ensure all aspects
of clinical guidelines are addressed for pharmacist review.
* Review and analyze pharmacy claims data for proactive outreach
and intervention.
* Identify, document, and escalate provider concerns to the
appropriate internal team including various members of the Prior
Authorization Team
* Triage phone calls from members, pharmacy personnel, and
providers by asking applicable drug and client specific clinical
questions.
* Effectively communicate issues and resolutions to members,
pharmacy staff, providers, and appropriate internal
stakeholders.
* Follow all internal Standard Operating Procedures and adhere to
HIPAA guidelines and Company policies
* Ensure customer satisfaction, extraordinary customer care, and
quality resolution with genuine compassion in a fast paced, startup
environment
Required Qualifications:
* 2+ years of pharmacy technician experience in a PBM, health plan,
or in another clinical pharmacy setting
* Experience handling prior authorization requests/understanding of
prior authorization requirements required
* National Certified Pharmacy Technician (CPhT) license,
preferred
* High school diploma or the equivalent; Associates or bachelors
degree is preferred
* Excellent communication, writing, and organizational skills
* Ability to work independently with minimal supervision, stay
productive in a remote, high-volume, metric driven call center
environment
* Ability to multi-task and collaborate in a team with shifting
priorities
Base Salary: $45,000 - $55,000
This range represents the low and high end of the anticipated base
salary range for the NY - based position. The actual base salary
will depend on several factors such as: experience, knowledge, and
skills, and if the location of the job changes.
Capital Rx values a diverse workplace and celebrates the diversity
that each employee brings to the table. We are proud to provide
equal employment opportunities to all employees and applicants for
employment and prohibit discrimination and harassment of any type
without regard to race, color, religion, age, sex, national origin,
disability status, medical condition, genetic information,
protected veteran status, sexual orientation, gender identity or
expression, or any other characteristic protected by federal, state
or local laws.
Keywords: Capital Rx, Inc, New York , Prior Authorization Technician - Pharmacy Technician, Healthcare , New York, New York
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