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Prior Authorization Technician #26-25795

US Tech Solutions

Role overview

Qualifications

  • 1 to 3 Years of experience required
  • High School/GED Required
  • Certified Pharmacy Technician (PTCB or NHA)
  • Minimum 35 words per minute typing speed

Responsibilities

  • Interprets and applies clinical criteria during the prior authorization review process
  • Utilizes member claims history during the prior authorization review process
  • Makes outbound calls to obtain additional information needed to process prior authorization requests
  • Submits authorizations to pharmacy and medical claims processors

Key facts

Hard skills

Other skills

  • Multitasking
  • Adaptability

About the company

US Tech Solutions logo

US Tech Solutions

Staffing & Recruiting

USTECH SOLUTIONS is the largest privately owned diversity workforce partner with a global footprint. For 20+ years, we have partnered with leading MSPs and some of the world’s largest enterprises to deliver a flexible workforce. We serve Fortune 500 giants and growing businesses alike, reinventing the role of humans in a digital workforce. ‘Reinventing Human’ is about connecting you with top talent and seamlessly integrating new hires into your programs through our next gen AI powered Talent platforms. As the largest private diversity supplier in the US, we champion inclusion and unlock hidden potential. We work with leading MSPs and are a trusted strategic partner to the world’s top brands. At USTECH SOLUTIONS, we're inverting the talent hiring pyramid by offering a range of solutions from curated talent pools, workforce management services, and IT services resourcing to IC compliance. Our legacy and close affinity to the computing industry has equipped us with the expertise and vision to provision AI platform solutions that help organizations to innovate faster. Considering Statement of Work? Meet US Tech Digital (ustechdigital.com). We're helping businesses achieve digital leadership through our tailored SOW solutions, utilizing market-leading technology products and our proprietary in-house developed platform solutions. Explore our full range of services and solutions by visiting our website: ustechsolutions.com

Company details

Company typeLarge
IndustryStaffing & Recruiting
Company size1001 - 5000

Links

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Job description

Duration: 3 months with possible extension

Summary:
  •  Prior Authorization Technician I processes prior authorization requests received from providers, members, and pharmacies, including requests for high cost and specialty medications.
Responsibilities
  •  Interprets and applies clinical criteria during the prior authorization review process and approves requests if applicable
  • Utilizes member claims history during the prior authorization review process
  • Makes outbound calls to obtain additional information needed to process prior authorization requests
  • Submits authorizations to pharmacy and medical claims processors
  • Forwards prior authorization requests to a pharmacist when necessary
  • Makes appropriate referrals to other clinical programs
  • Assists in directing appropriate requests to in network providers
  • Receives inbound calls from the customer care center with prior authorization related inquiries
  • Assist with Appeals processing as assigned
  • Ability to multitask between various tasks and systems while maintaining required productivity and quality levels
  • Ability to make changes in a fast-paced environment
  • Strong knowledge of specialty and non-specialty pharmaceuticals
  • Performs other job-related duties and projects as assigned  
  • Attends required training on an annual basis.
  • Adheres to corporate and departmental policies and procedures.
  • Available to work weekends and holidays.
Experience:
  • 1 to 3 Years required.
  • Previous PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience preferred. 
  • Minimum 35 words per minute typing speed.
Education:
  • High School/GED Required
  • Certified Pharmacy Technician (PTCB or NHA).

Required Skills:
  • Prior authorization processing
  • Clinical criteria interpretation
  • Member claims history utilization
  • Outbound calling
  • Authorization submission

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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