Certified Pharmacy Technician I
*This is a remote position – Must be in the state of VA only, please
*Schedule: Monday – Friday, 9:00 am – 8:00 pm EST, Overtime
Job Description:
- SA Certified Pharmacy Technician in a call center evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile (fax) using client clinical criteria in a call center environment.
Responsibilities:
- Assist with inbound and/or outbound patient or physician calls.
- Research and resolve rejected insurance billing issues and/or escalated member issues.
- Determines appropriateness for medications. Communicates decisions to physicians, physicians’ office staff, medical management staff, and/or pharmacists.
- Research, resolve, and document prior authorization outcomes in the pharmacy system.
- Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physicians’ office staff, medical management staff, and/or pharmacists.
- Escalates requests to the pharmacist when the request requires extensive clinical review or denial.
- Researches, resolves, and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider, and/or management.
- Efficiently multitasks and monitors multiple queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).
- For CPTs assigned to work the fax queue, responsibilities will also include.
- Clinically reviews coverage determinations with attention to detail for medications via Fax.
- Communicates decision to physicians, physician`s office staff, medical management staff, and/or pharmacists within SLA (service level agreement) guidelines.
- Performs other duties as required.
Skills/Knowledge/Experience:
- 0 to 2 years of Pharmacy Technician experience.
- Call center customer service experience, some retail background, and ability to work independently from home.
- Basic computer skills.
- The agent will be taking inbound calls.
Education
- High School diploma.
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