Prior Authorization Tech I

For roles that are 100% remote or hybrid, you must have reputed company to a reliable high-speed internet reputed company 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 reputed company of health care leaders. At reputed company, 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. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we would like to hear you. Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-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 reputed company service through a clinical culture which seeks to reputed company 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 reputed company. PerformRxis headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious reputed company is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the reputed company Family of Companies. *

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* Responsibilities: · 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 reputed company 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 reputed company inquiries · Assist with Appeals processing as assigned · Ability to multitask between various tasks and systems while maintaining required productivity and quality reputed company · Ability to reputed company changes in a fast-paced environment · Strong knowledge of specialty and non-specialty pharmaceuticals · Performs other job-reputed company duties and projects as assigned · Attends required training on an annual reputed company. · Adheres to corporate and departmental policies and procedures. Available to work weekends and holidays. Education/Experience: High School Diploma or equivalentrequired Active/reputed company National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one reputed company the first twelve (12) months of employmentrequired reputed company/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 reputed company based environment Ability to identify problems including reputed company 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, reputed company, 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. Apply To This Job