Job Summary
This position supports the Allegheny Health Network's centralized prior authorization department. It coordinates and administers the effective and efficient processing of pharmacy benefits prior authorization, ensuring compliance with all regulatory agency requirements.
Essential Responsibilities
* Reviews pharmacy utilization management (UM) coverage requests and prepares cases for clinical review by a pharmacist and/or medical director when necessary.
* 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.
* Ensures swift and appropriate payment of services deemed medically necessary by entering preauthorization information into applicable databases.
* Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and notification requirements.
Experience
* Requires 2 years of experience as a Pharmacy Technician in a hospital, retail, or managed care setting.
Skills
* Strong knowledge of medical and pharmaceutical terminology.
* Strong verbal and written communication skills.
* Well-organized with attention to detail.
* Ability to identify and resolve problems.
* Ability to handle multiple priorities in a timely manner.
* Strong interpersonal skills.
* Ability to work independently or in a team environment.
* Customer-oriented.
* Proficient in Microsoft Office products (Word, Excel, PowerPoint).
Educational Requirements
* Associate degree required.
Licenses or Certifications
* Certified Pharmacy Technician (CPhT) from the Pharmacy Technician Certification Board is required.