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 FunctionsInterprets and applies clinical criteria during the prior authorization review process and approves requests if applicableUtilizes member claims history during the prior authorization review processMakes outbound calls to obtain additional information needed to process prior authorization requestsSubmits authorizations to pharmacy and medical claims processorsForwards prior authorization requests to a pharmacist when necessaryMakes appropriate referrals to other clinical programsAssists in directing appropriate requests to in network providersReceives inbound calls from the customer care center with prior authorization related inquiriesAssist with Appeals processing as assignedAbility to multitask between various tasks and systems while maintaining required productivity and quality levelsAbility to make changes in a fast-paced environmentStrong knowledge of specialty and non-specialty pharmaceuticalsPerforms other job-related duties and projects as assignedAttends 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.Education:High School/GED RequiredCertified Pharmacy Technician (PTCB or NHA). May be required to be licensed or certified in a specific state based upon contractual requirements and business need.Requires working shift schedule outside standard business hoursMust remain in stationary position for long periods of time at desk or computerRequires moving around office and non-office locationsRequires frequently moving about inside the office to access printer, files, and other materials/equipmentOperates a computer and other office equipmentRequires ability to Lift/Carry/Push/Pull - Typically less than 10 poundsSkills:RequiredPrior Authorization ProcessingClinical Criteria InterpretationMember Claims History UtilizationOutbound CallingAuthorization SubmissionAdditionalAdaptabilityReferral ManagementAppeals ProcessingMultitaskingSpecialty Pharmaceuticals KnowledgeNon-Specialty Pharmaceuticals KnowledgeTyping Speed (35 WPM)PBM ExperienceManaged Care ExperienceHospital Pharmacy ExperienceLTC Pharmacy ExperienceHome Infusion Pharmacy ExperienceRetail Pharmacy ExperienceNotes:Position is remote.Shift Schedule: 8:30am-5:00pm EST, 9:00am-5:30pm EST, or 9:30am-6:00pm EST
At VIVA, employee well-being is paramount. Our comprehensive benefits package ensures your health, financial security, and quality of life are always prioritized.
VIVA provides employees access to a comprehensive group health insurance plan (Medical, Dental, Vision, Basic Life, Term Life, and Accidental Death) through our flexible PPO plan-allowing you the freedom to choose healthcare providers.
Plan securely for your future with automatic payroll deductions into a tax-advantaged 401(k) retirement plan, including employer-matching contributions for eligible employees.
Earn performance-based bonuses and generous referral incentives of up to $500 when recommending talented candidates who become part of the VIVA family.
Enjoy timely and convenient payroll with biweekly direct deposit to your chosen financial institution. Biweekly Direct Deposit
Access exclusive employee discounts and savings on electronics, travel, groceries, apparel, and more through our dedicated VIVA Perks Program.