Prior Authorization Technician I

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

PerformRxis 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.

PerformRxis 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 Companies.

*** OPEN TO CANDIDATES NATIONWIDE ***

Responsibilities:

Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Prior Authorization Technician I assist in the prior authorization process.

• Understand and apply clinical criteria for processing pharmacy and medical billing Prior Authorization requests in a timely manner. Make outbound calls/receive inbound calls, speak with physicians’ offices for additional information and/or clarification needed to process prior authorization request.

• Support the Fraud and Abuse program system oversight by reviewing medication utilization records. Communicate any suspected fraud discovered. Recommend course of action for Providers where patterns appears outside of guidelines and generally accepted pharmacy standards.

• Keep abreast of industry trends and regulatory changes in the pharmacy industry and incorporate knowledge while performing job duties. Identify problems in process/procedures and/or services and make recommendations for improvements. Maintain a balance of productivity, quality and timeliness of job accountabilities. Participate in department self-audit procedures for on-going evaluation of service.

• Maintain and update internal databases. Enter application information, prior authorizations and other relevant data. Ensure database information and appended files are current and accessible to staff. Generate reports and other information requested on a scheduled/as needed basis.

• Create and support an environment which fosters teamwork, cooperation, respect and diversity

• Establish and maintain positive communication and professional demeanor with internal and external business partners at all times

• Perform other related duties as assigned

• Attend required training on an annual basis

• Adhere to AMFC policies and procedures

*** Must be available to work weekends and holidays. ***

Education/Experience:

• High School Diploma or equivalentrequired
• Active/current National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one within the first twelve (12) months of employmentrequired
• Current/recentPharmacy Benefit Manager (PBM), managed care, hospital pharmacy, long-term care (LTC) pharmacy, home infusion pharmacy, and/or retail pharmacy experience preferred

Requires:

• Knowledge of pharmacy practices, procedures and precedents; ability to read and understand pharmaceutical information
• Working knowledge of drug dosage forms, drug strength, generic & trade name equivalent
• Demonstrate 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 setting
• Must be organized, detail-oriented and have excellent communication skills (listening, verbal, written, grammar)

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO) including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement and more.