Prior Authorization Specialist (Pharmacy Technician)

Summary

The Prior Authorization Pharmacy Technician is responsible for coordinating comprehensive data elements, insurance verification, and clinical information for prescription pre-authorization management. Maintains knowledge of third party reimbursement regulations and medical terminology. Requires ability to identify specified issues and bring to the attention of the Pharmacist-In-Charge.

Location

This position is based in Omnicell's Specialty Pharmacy Services corporate office:

1620 W Northwest Hwy, Suite 100

Grapevine, TX 76051

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Research and investigate Prior Authorization (PA) requirements by drug/insurance company.
• Obtain Prior Authorization status updates from the insurance company and communicate to the physician's office.
• Review clinical information provided by the physician's office and communicate the necessary information to the insurance company.
• Submit PA application forms and all required supporting documentation to the insurance company.
• Communicate with the physician's office to obtain necessary information on a timely basis.
• Seek clarifications from the physician's office as necessary.
• Compose "Letters of Medical Necessity".
• Review denials; communicate the denial reasons to the physician's office.
• Prepare and send Patient Status Reports to the physician throughout the PA process.
• Understand various challenges and designed processes of specific diseases/drugs.
• Performs data entry, including patient demographic, billing, medical history, and prescription information.
• Conducts insurance verification, coordination of benefits, co-pay collection.
• Performs specialty and retail order scheduling.
• Effectively routes prescription referrals as necessary.
• Assists specialty patients with PAP/Foundation information.
• Proactively performs Refill Management functions.
• Effectively triages customer’s questions and needs to the appropriate staff member.
• Provides excellent customer service as evidenced by a willingness and ability to assist customers with their questions/concerns, treating customers in a friendly and helpful manner, and maintaining a positive attitude.
• Upholds patients’ rights including privacy and confidentiality.
• Follows up with insurance companies in a timely manner regarding prior authorizations and billing.
• Participates in Quality Improvement activities and projects.
• Performs other duties as assigned.

Basic Requirements

• High school diploma or GED
• Active, non-expired license/registration with the Texas State Board of Pharmacy
• Active Nationally Certified Pharmacy Technician (CPhT): PTCB or NHA accepted.
• Working knowledge of Pharmacy Technician duties

Preferred Qualifications

• Three (3) years of prior authorization experience strongly preferred
• Specialty pharmacy experience preferred

Competencies

• Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner.
• Must be detailed oriented, with strong organizational and multi-tasking skills.
• Communicates effectively with patients, colleagues/employees of organization, and external associates.
• Ability to interact and communicate with people over the phone, sometimes in stressful situations.
• Ability to understand and follow instructions, work independently and efficiently.
• Basic data entry and/or word processing skills.
• Ability to verify data input and correct errors.
• Conveys empathy and understanding when handling customer service issues.

Work Environment and Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. While performing the duties of this job, the employee is regularly required to talk and hear. The ability to see distinctions in colors and shapes is also required.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
• This position requires the ability to handle stressful situations in a calm and courteous manner at all times.
• This position also requires the ability to:
  • Sit, use hands to handle or feel, talk and hear constantly 67-100% of time OR 6 or more hours.
  • Reach with hands and arms frequently 34-66% of time OR 4-6 hours.
  • Stand, walk and stoop, kneel and crouch occasionally 0-33% of time OR 1-3 hours.
  • Lift and/or move up to 10 to 25 pounds occasionally 0-33% of time OR 1-3 hours.

Base Compensation: $22.00 to $24.00

(Actual compensation is subject to variation due to such factors as location, education, experience, and skillset. We offer a comprehensive benefits package, including medical, dental and vision plans covering eligible US employees and dependents, voluntary wellness and employee assistance programs, life insurance, disability, retirement plans with matching, and paid time off.)