Prior Authorization Technician I Duration: 3+ Months
Location: Remote
Experience: 1–3 Years
Shift: EST hours
• 8:30 AM – 5:00 PM
• 9:00 AM – 5:30 PM
• 9:30 AM – 6:00 PM
Weekend/Holiday: Must be available as needed.
Position is remote. No time zone preference but shift times offered will be in EST time so candidates will need to adjust accordingly if in a different time zone. Shift Schedule: 8:30am-5:00pm EST, 9:00am-5:30pm EST, or 9:30am-6:00pm EST
Required
• PRIOR AUTHORIZATION PROCESSING
• CLINICAL CRITERIA INTERPRETATION
• MEMBER CLAIMS HISTORY UTILIZATION
• OUTBOUND CALLING
• AUTHORIZATION SUBMISSION
Duties:
Reporting directly to the Supervisor, Prior Authorization Technicians, the Prior Authorization Technician I processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications.
Essential Functions
Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable
Utilizes member claims history during the prior authorization review process
Makes outbound calls to obtain additional information needed to process prior authorization requests
Submits authorizations to pharmacy and medical claims processors
Forwards prior authorization requests to a pharmacist when necessary
Makes appropriate referrals to other clinical programs
Assists in directing appropriate requests to in network providers
Receives inbound calls from the customer care center with prior authorization related inquiries
Assist with Appeals processing as assigned
Ability to multitask between various tasks and systems while maintaining required productivity and quality levels
Ability to make changes in a fast-paced environment
Strong knowledge of specialty and non-specialty pharmaceuticals
Performs other job-related duties and projects as assigned
Attends required training on an annual basis.
Adheres to corporate and departmental policies and procedures.
Available to work weekends and holidays.
Skills:
1 to 3 Years required.
Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred.
Minimum 35 words per minute typing speed.
#AlliedTech1
Remote
Skills:
Biotech and Pharmaceutical, Customer Support/Service, Hospital Administration, Managed Care, Medications, Multitasking, Pharmacy, Retail, Typing
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TalentBurst, Inc.
For over 20 years, TalentBurst Inc. has been an award-winning provider of cutting-edge Workforce Management Solutions. With a strong commitment to staying ahead in the tech landscape, we pioneer innovative approaches to talent acquisition. Our expertise spans Life Sciences, and Healthcare Staffing, Banking, Financial, IT, and Engineering, as well as Global Employer of Record (EOR), Agent of Record (AOR), State, Local Government and Education (SLED), and IC validation/compliance services. Additionally, our division, TalentProcure, leads the industry with offerings such as High Hazard Payroll, Managed Services, and Vendor on Premise (VOP) solutions.
Due to our prioritization of excellent standards, we are Joint Commission Certified and are a certified Minority Business Enterprise (MBE) in the USA and Canada. Supporting over 130 Fortune 500 companies globally, we excel in navigating the landscape of talent acquisition. In a world of constant change, we embrace developing people-centric solutions that address the unique demands of our clients. Stay connected by visiting our website and following us on social media!
Company Size:
5,000 to 9,999 employees
Industry:
Staffing/Employment Agencies
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2002
Website:
http://www.talentburst.com/