Prior Authorization Specialist (Pharmacy Technician I)

Full Time
Remote
Posted
Job description

Job Purpose

Ventegra is a rapidly growing, fast paced, innovative virtual company. As part of Ventegra, the Pharmacy Technician I, provide daily operational support to the Pharmacist and Customer Care Specialist related to prior authorizations. The Pharmacy Technician I, has the clinical skills to review and evaluate the appropriateness and medical necessity of medications based on established criteria. The Pharmacy Technician I, promotes and supports quality pharmacy services.

Duties

  • Maintain an accurate and current knowledge of required criteria, training materials, systems, prior authorization processes and plan benefits.
  • Accurately enter authorizations approvals in the claims processing system.
  • Accurately document case notes relate to member’s medications as required in the prior authorization review process.
  • Review incoming fax request for medications requiring a prior authorization, while ensuring an elevated level of customer service and maximizing productivity. Requests additional information from providers as needed to properly evaluate the request.
  • Assist Clinical Pharmacist by providing accurate documentation and clear clinical notes related to a prior authorization request.
  • Provide clinical review and determinations of prior authorization in keeping with legal and contractual requirements, including turnaround times and service level agreements.
  • Escalate issues through the appropriate channel of management to ensure patient has access to medications.
  • Effectively manages and prioritize prior authorization requests based on turn-around times.
  • Effectively communicates both internally and externally to enhance the effectiveness of pharmacy prior authorization process and ensure the needs of the members and clients are met.
  • Must maintain the highest level of member confidentiality and adheres to all company policies regarding confidentiality and HIPAA.
  • Assist in the processing of telephonic prior authorizations request from physicians using established criteria and guideline.
  • Assist with other duties and responsible as assign by management based on department needs.

Skills/Qualifications

  • Excellent verbal and written communication skills.
  • Ability to focus and prioritize.
  • Accurate and detail oriented.
  • Ability to multi-task with minimal direction.
  • Flexibility and ability to adapt to changes and updates to processes and protocols.
  • Demonstrate problem-solving skills, information gathering, research, alternatives analysis, applying creative solutions to unique and/or immediate issues.
  • High volume call center experience a plus.
  • Experience processing in pharmacy prior authorization request using medication criteria.
  • Proficient in Microsoft Office programs (Word, Excel, Outlook, etc.).
  • High School Diploma or GED equivalent.
  • Current Certified Pharmacy Technician License (CPhT) required.
  • 1-year experience as a Pharmacy Prior Authorization Technician or minimum 18 month as a Ventegra Customer Care Specialist (CCS).

About Ventegra

Ventegra is the premier, fully transparent Pharmacy Services Administrator (PSA) helping to manage health care costs for businesses and consumers. Ventegra is committed to seeking innovative ways to channel our resources for a greater impact to improve the lives of others. Ventegra represents payors, providers, PBM’s and Government programs.

Job Type: Full-time

Pay: $20.00 per hour

Benefits:

  • 401(k)
  • Dental insurance
  • Employee assistance program
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • Monday to Friday

COVID-19 considerations:
All employees are required to be vaccinated against COVID-19 prior to hire.

Experience:

  • Pharmacy Prior Authorization: 1 year (Required)

License/Certification:

  • Pharmacy Technician Certification (CPhT) (Required)

Work Location: Remote

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