Job Information
Healthfirst Remote UM Pharmacy Technician in Remote, New York
Duties & Responsibilities:
Reviews prior authorization requests and units for medications requested under the medical benefit
Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
Sends notification to members and providers of authorization decisions via telephone, fax, or mail
Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
Establishes great rapport with Provider offices via telephonic communication
Sends request for information sheets to Providers
Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
Additional duties as necessary
Minimum Qualifications:
High School Diploma or GED from an accredited institution
Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
Experience conducting prior authorization reviews
Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional
Preferred Qualifications:
Strong written and verbal communication skills in Chinese, Spanish, or Russian
Demonstrated critical thinking and problem-solving skills
Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities
Knowledge of specialty pharmaceuticals and billing practices in the medical benefit
Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local
Coverage Determinations
PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).
Experience with TruCare Care Management Platform
Compliance & Regulatory Responsibilities: Noted above
License/Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.