Job Title:
Alegheny Health Network Prior Authorization Coordinator
Description:
This position plays a crucial role in supporting the network's centralized prior authorization department.
Duties and Responsibilities:
* Reviews pharmacy utilization management (UM) coverage requests and prepares cases for clinical review by a pharmacist and/or medical director when required.
* Applies plan-specific benefits to each case, summarizes pertinent facts, and cites applicable internal policies and guidelines.
* Resolves non-clinical issues independently and acts as a liaison between customer-facing teams and the Corporate Pharmacy Department.
* Maintains regulatory compliance and resolves all cases within predetermined timeframes.
* Enters preauthorization data into applicable databases to ensure swift payment of medically necessary services.
* Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests and processing errors.
Requirements:
* 2 years of experience as a Pharmacy Technician in a hospital, retail, or managed care setting.
* Certified Pharmacy Technician (CPhT) from the Pharmacy Technician Certification Board.
Preferred Qualifications:
* Strong knowledge of medical and pharmaceutical terminology.
* Excellent verbal and written communication skills.
* Well-organized with attention to detail.