Position Summary

The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.

The Tech I will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

The Pharmacy Technician is responsible for placing outbound calls to physician offices to obtain verbal authorization for prescription refill renewals when previous outreach attempts have not received a response. This role supports continuity of patient care by ensuring refill requests are addressed in a timely and compliant manner while maintaining professionalism and accuracy in all communications.

Responsibilities
40% - Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards.
40% - Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
10% - Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
5% - Identify and elevate clinical inquiries to the pharmacist team as appropriate.
5% - Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc.

Duties
Required Skills and Qualifications
Strong verbal communication and professional phone etiquette.
Ability to speak confidently with physician office staff and healthcare professionals.
Basic computer proficiency and ability to navigate multiple systems simultaneously.
Strong attention to detail and accurate documentation skills.
Ability to manage repetitive tasks while maintaining quality and focus.
Ability to set up computer, vpn and other application at home
Ability to work independently and as part of a team.

Required Qualifications
Able to apply basic computer skills. Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
Must be able to multitask and utilize multiple system applications simultaneously.
Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.
Must be able to utilize available resources independently and provide high quality work.
Must be able to absorb presented information, display motivation, seek development and problem solve.
Ability to adapt and change with workflow and shifting priorities.
Must possess excellent written, verbal, grammar, and listening communication skills.
Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
Ability to maintain confidentiality of PHI (Protected Healthcare Information).

1. Regular and predictable attendance
2. Colleague will be required to work mandatory overtime/extended work week when needed
3. Colleague will be required to travel when needed
4. Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.
5. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
1. Long periods of sitting (up to 100%)
2. Talking on the phone for extended periods of time (90-100%)
3. Reading a computer screen for extended periods of time (100%)
4. Light lifting of less than 10 lbs (5%)

Experience
Preferred Qualifications
0 to 3 years experience
Previous experience in a call center, healthcare, pharmacy, or customer service environment.
Familiarity with prescription refill processes and medical office workflows.
Knowledge of HIPAA regulations and patient confidentiality requirements.

Education Required:
Verifiable High School Diploma or GED

License Requirement:
Pharmacy License Preferred, Not Required

Education
R | H.S or Equivalent
P | Associate Degree or Bachelor’s Degree: If neither degree held, then equivalent years of work experience.
P | Other Certificates or Licenses (List): Active pharmacy technician license per state requirements, or active national certification.? Trainee license in states where applicable.

Notes:
100% Remote (Work From Home)
Schedule:
Training: Monday-Friday, 8:00 AM - 4:30 PM CST
Production: Monday-Friday, 10:00 AM - 7:30 PM CST