Description

:  JOB SUMMARY *This position is eligible for a $5,000 sign on bonus for a 1-year commitment* This position supports the network centralized prior authorization department. Coordinates and administers the effective and efficient processing of the pharmacy benefits prior authorization process, ensuring that pharmacy benefits are administered in accordance with all regulatory agency requirements

ESSENTIAL RESPONSIBILITIES Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%)

Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines. (20%)

Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Corporate Pharmacy Department. (20%)

Maintain regulatory compliance and resolves all cases within predetermined timeframes. (15%)

Responsible for all preauthorization entries into applicable databases (i.e. internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary. (20%)

Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others. (5%)

May perform other non-clinical duties as required by management and department needs.

QUALIFICATIONS Required 2 years of experience as a Pharmacy Technician, Patient Access Coordinator, or Medical Assistant in health care setting

Preferred Associate degree

Certified Pharmacy Technician (CPhT) from Pharmacy Technician Certification Board

Language (Other than English): None Travel Requirement: 0% - 25% Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at