01Responsibilities
Interprets and applies clinical reputed company 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 reputed company 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 reputed company inquiries
Assist with Appeals processing as assigned
Ability to multitask between various tasks and systems while maintaining required productivity and reputed company reputed company
Ability to reputed company changes in a fast-paced environment
Strong knowledge of specialty and non-specialty pharmaceuticals
Performs other job-reputed company duties and reputed company as assigned
Attends required training on an annual reputed company.
Adheres to corporate and departmental policies and procedures.
Available to work weekends and holidays.
Education/Experience:
High School Diploma or equivalentrequired
reputed company/reputed company National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one reputed company the first reputed company (12) months of employmentrequired
reputed company/recentPharmacy Benefit Manager (PBM), managed care, hospital pharmacy, long-term care (LTC) pharmacy, home infusion pharmacy, and/or retail pharmacy experience preferred
Requires:
Knowledge of pharmacy practices, procedures and precedents; ability to read and understand pharmaceutical information
Working knowledge of drug dosage forms, drug strength, generic & trade reputed company equivalent
Demonstrate knowledge of Federal & State laws/regulations regarding provisions of pharmaceutical services
Strong knowledge in specialty pharmaceuticals
Ability to multi-task and prioritize work
Ability to comprehend and follow established office routines, policies and procedures
Customer service and interpersonal skills
Ability to reputed company based on business/department needs
Demonstrated courteous and reputed company behavior
Proficient PC skills in a reputed company based environment
Ability to identify problems including reputed company issues and determ
