[Hiring] Specialty Pharmacy Technician Prior Authorization @CenterWell

Role Description

The Specialty Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/technical/operational/customer support assignments. Typically work on semi-routine assignments and daily follow-ups. Work with providers' offices and insurance to troubleshoot and complete medication prior authorization requests for specialty medications.

$1,500 Sign-On Bonus ($750 upon hire and a second $750 payment after completing 6 months (180 days) of employment)

The Specialty Operations Pharmacy Technician 2 (Prior Authorizations) will oversee the following:

• Manage daily worklists, conducting follow-ups, and prioritizing authorization requests.
• Research and interpret insurance claims, while using a broad array of clinical and informational resources to obtain relevant authorization information.
• Work directly with physician offices to initiate and complete prior authorization requests, ensuring compliance with quality standards and departmental protocols.
• Operate with opportunities for independent discretion and interpretation within established guidelines, supporting the delivery of high-quality patient care and operational excellence.

Qualifications

• Must have an active license with the Board of Pharmacy in the state of residence (Ohio, Florida, Texas or Arizona).
• Must be certified by the Pharmacy Technician Certification Board (PTCB) or through ExCPT with an active certification.
• Must be able to research, read & interpret clinical information.
• Critical thinker who can anticipate member/customer needs and take initiative, ask the right questions and deliver the highest quality customer experience.
• Problem solver who can find viable solutions that meet member/customer needs, absent from all ideal tools.
• Experience using multiple applications simultaneously and data entry skills.

Requirements

• 2+ years of experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting.
• Mail Order Pharmacy or Specialty Pharmacy experience.
• Experience working with insurance plans and Medicare.
• 1+ years of experience submitting and reading pharmacy claims, in RxNova.
• Experience with Scriptmed.

Benefits

• Competitive benefits that support whole-person well-being.
• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Additional Information

• Hours: The preferred hours of operation for this position will be an 8-hour shift sometime between the hours 8 a.m.-5:30 p.m. EST.
• Overtime: When there is a business need, overtime will be requested. Potentially voluntary or mandatory.
• Holidays: When there is a business need to work on a holiday outside of Thanksgiving Day and Christmas Day, there is the possibility of working on a holiday.
• Work at Home Requirements:
  • Minimum download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40.
• Pay Range: $40,000 - $52,300 per year.