Careers Integrated Resources Inc
Prior Authorization Technician I
Careers Integrated Resources Inc, Philadelphia, Pennsylvania, United States
Job Title: Prior Authorization Technician I
Location: Philadelphia, PA 19113 (REMOTE)
Duration: 3-4 months (Contract)
Shift: 40 Hours Per Week/ 5 Days per week
Duties: The Prior Authorization Technician I assists in the prior authorization process. Reports directly to the Supervisor, Prior Authorization Technicians. Processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications. 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.
Shift: 40 Hours Per Week/ 5 Days per week
Duties: The Prior Authorization Technician I assists in the prior authorization process. Reports directly to the Supervisor, Prior Authorization Technicians. Processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications. 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.