Clinical Pharmacy Technician I | Prior Authorization | Remote
Job Purpose Ventegra is a rapidly growing, fast paced, innovative virtual company. As part of Ventegra, the Pharmacy Technician I, provide daily operational support to the Pharmacist and Customer Care Specialist related to prior authorizations. The Pharmacy Technician 1 has the clinical skills to review and evaluate the appropriateness and medical necessity of medications based on established criteria. The Pharmacy Technician I, promotes and supports quality pharmacy services. Duties and Responsibilities
- Maintain an accurate and current knowledge of required criteria, training materials, systems, prior authorization processes and plan benefits
- Accurately enter authorizations approvals in the claims processing system
- Accurately document case notes relate to member’s medications as required in the prior authorization review process
- Review incoming fax requests for medications requiring a prior authorization, while ensuring an elevated level of customer service and maximizing productivity. Requests additional information from providers as needed to properly evaluate the request
- Assist Clinical Pharmacist by providing accurate documentation and clear clinical notes related to a prior authorization request
- Provide clinical review and determinations of prior authorization in keeping with legal and contractual requirements, including turnaround times and service level agreements
- Escalate issues through the appropriate channel of management to ensure patient has access to medications
- Effectively manages and prioritize prior authorization requests based on turn-around times
- Effectively communicates both internally and externally to enhance the effectiveness of pharmacy prior authorization process and ensure the needs of the members and clients are met
- Must maintain the highest level of member confidentiality and adheres to all company policies regarding confidentiality and HIPAA
- Assist in the processing of telephonic prior authorizations request from physicians using established criteria and guideline
- Assist with other duties and responsible as assign by management based on department needs
Required Skills and Abilities
- Excellent verbal and written communication skills
- Ability to focus and prioritize
- Accurate and detail oriented
- Ability to multi-task with minimal direction
- Flexibility and ability to adapt to changes and updates to processes and protocols
- Demonstrate problem-solving skills, information gathering, research, alternatives analysis, applying creative solutions to unique and/or immediate issues
- High volume call center experience a plus
- Experience processing in pharmacy prior authorization request using medication criteria
- Proficient in Microsoft Office programs (Word, Excel, Outlook, etc.)
- Dependability and good attendance are an essential function of the job
Education and Experience
- High School Diploma or GED equivalent.
- Current Pharmacy Technician License required; Certified Pharmacy Technician License (CPhT) required
- 1-year experience as a Pharmacy Prior Authorization Technician or minimum 1-year experience as a Ventegra Customer Care Specialist (CCS) with Technician Certification (CPhT required)
- 1-year experience as a Pharmacy Benefit Management(PBM) Prior Authorization Technician preferred
Work environment requirements A home office setting, free from noise and distraction allowing you to interact professionally both externally and internally. Pay: $20.00 per hour Application Question(s):
- Do you have a valid PTCB or NHA pharmacy technican certification?
- Are you available to work any time from 6:00am PST to 7:00pm PST?
- Do you have Pharmacy Benefit Management(PBM) experience? If yes, how many years?
- Are you authorized to work in the United States?
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