RemX is seeking a Pharmacy Tech interested in starting May, 2023. This position focuses on completing criteria based prior authorizations for Specialty medications under the medical benefit. The Pharmacy Technician - Prior Authorization is responsible for the efficient, accurate and timely prioritization and management of work.
Pay Rate: $19.00/hr
Start: 5/2023
Type: Contract – 3 months
Address: REMOTE
RI 02895 – Does not need to live near site
Schedule: Must be available between Mon – Sun 8:00 AM – 12:00 AM CST ; schedule assigned after 3 weeks of training, potential for weekend
Training: Approximately 3 weeks – M – F 8:00 AM – 4:30 PM CST, then scheduled will be assigned.
Active Pharmacy Tech License per resident state requirements. Not needed if state doesn’t require.
Job Responsibilities:
- Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards. Sort incoming faxes in compliance with departmental and client requirements.
- Manage case load of for all clients by researching and triaging incoming fax requests. Use eligibility systems to identify the type of request and create, route, and/or complete appeals or requests in accordance with department processes. Process External Review appeal requests according to federal, client, and state mandated guidelines.
- Act as a subject matter expert and assists with Coordinator duties dependent upon business needs. Provides support/mentoring to Coordinator staff to solve case processing questions and issues.
- Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for timely resolution of issues with case processing.
- Works closely with internal partners to develop work instructions and promote process improvements.
- Provides support to the Prior Authorization Department in meeting client expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making.
- Responsible for maintaining compliance with ERISA, CMS, and client specific requirements.
- This position is also responsible for receiving calls from physician offices and providing professional and courteous assistance to all callers through the criteria-based process.
- Will follow criteria question set prompts to facilitate system-generated approvals. Further responsibilities include maintaining complete, timely, and accurate documentation of all requests, communicating to the physician’s office, pharmacies, intake etc. as needed, and transfers all clinical questions and judgement calls to the Clinical Pharmacist as needed.
- Will also assist with other duties such as outbound calls, monitoring/responding to inquiries in mailboxes and other duties as assigned by the leadership team.
- Will support requirements of the PA team by working as part of a weekend coverage team on a rotating basis when needed.
