[Hiring] Pharmacy Prior Authorization Representative @Gainwell Technologies LLC

Role Description

The Pharmacy Prior Authorization Call Center (PPAAC) Representative supports the Connecticut Medicaid account in a fast-paced, high-volume call center environment. This role is responsible for answering and resolving inquiries from prescribers and pharmacies related to pharmacy claims and prior authorization requests, ensuring timely, accurate, and compliant processing.

• Serve as a primary point of contact for prescribers and pharmacies regarding pharmacy claims and prior authorization inquiries.
• Analyze pharmacy claims and provide accurate clarification, verification, and resolution to provider inquiries.
• Process prior authorization requests, including approvals and denials, and document rationale in accordance with policy.
• Accurately document all call interactions, inquiries, decisions, and resolutions in the system.
• Maintain confidentiality and compliance with HIPAA and Connecticut Medicaid guidelines.

Qualifications

• Knowledge of pharmacy claims processing and pharmacy dispensing systems, with exposure to Medicaid and/or Medicare Part D programs.
• Ability to work effectively in a high-paced, high-volume environment with strong multi-tasking and time management skills.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience working in a paperless, technology-driven environment.
• Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams.
• Active Connecticut Pharmacy Technician license, along with prior retail pharmacy or customer service experience.

Requirements

• Remote work opportunity, but must reside in Connecticut.
• Potential for in-office work in East Hartford as needed.
• 24/7/365 call center environment with rotating shifts:
• Monday – Friday: 7:30 AM – 7:30 PM
• Saturday (rotating schedule): 9:00 AM – 4:00 PM
• All off-hours are covered on an on-call rotation.
• A dynamic and fast-paced call center environment where accuracy and efficiency are key.
• Work from Home: Reliable high-speed internet connectivity is essential. Minimum requirements are 24 Mbps download and 8 Mbps upload, with higher speeds recommended for optimal performance.
• Interview Requirement: Video cameras must be used during all interviews.

Benefits

• The pay range for this position is $38,400.00 - $54,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.