- Remote, United States
- Remote
- Entry
- 3+ years
Responsible for performing prior authorizations and appeals for oral oncology and supportive medications, interacting with patients, caregivers, and healthcare providers, and supporting pharmacy staff in prescription processing.
Responsibilities
- Demonstrates effective communication skills and premier customer service to interact with all levels of internal and external parties
- Performs clinical reviews of patients’ charts using appropriate criteria to complete prior authorizations
- Process appeals for prior authorization denials according to specific insurance plan requirements, provides documentation and composes a letter of medical necessity
- Obtain prior authorization approvals utilizing online authorization sites (ex: Eviti, New Century Health, Cover My Meds) and prior authorizations via fax and phone
- Escalate complex clinical concerns to the appropriate clinician with a goal of first call resolution
Requirements
- High school diploma or GED
- Active Registered Florida Pharmacy Technician license
- Active National Pharmacy Technician Certification
- Nice to have: Prior Authorization Certified Specialist (PACS) certification
- Nice to have: Pharmacy benefit prior authorization experience