Job Summary

A company is looking for a Prior Authorization Technician I who will assist in the prior authorization process and review medication utilization records.

Key Responsibilities:

• Process pharmacy and medical billing Prior Authorization requests in a timely manner, including making outbound calls and receiving inbound calls to gather necessary information
• Support the Fraud and Abuse program by reviewing medication utilization records, identifying any suspected fraud, and recommending appropriate actions
• Maintain and update internal databases, generate reports, and participate in department self-audit procedures

Required Qualifications:

• High School Diploma or equivalent
• Active/current National Pharmacy Technician Certification or ability to obtain one within the first twelve (12) months of employment
• Experience in Pharmacy Benefit Manager (PBM), managed care, hospital pharmacy, long-term care (LTC) pharmacy, home infusion pharmacy, or retail pharmacy preferred
• Knowledge of pharmacy practices, drug dosage forms, and Federal & State laws/regulations regarding pharmaceutical services
• Strong knowledge in specialty pharmaceuticals and ability to multi-task and prioritize work