Prior Authorization Tech I

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

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.

Education/Experience:

• High School Diploma or equivalent required

• Active/current National Pharmacy Technician Certification (NHA or PTCB)

• Current/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 name 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 adjust based on business/department needs

• Demonstrated courteous and professional behavior

• Proficient PC skills in a windows based environment

• Ability to identify problems including complex issues and determine solutions, both independently or in a team/group setting

• Must be organized, detail-oriented and have excellent communication skills (listening, verbal, written, grammar)

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO) including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.