• Pharmacy Prior Authorization Technician

    Job Locations US-IL-Aurora
    Posted Date 1 month ago(12/10/2018 3:22 PM)
    # of Openings
    Medical Management
  • Overview




    Looking for a way to influence the health and healthcare of many?


    If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.


    UNITE HERE HEALTH serves 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!



    Key Attributes:

    • Integrity – Must be trustworthy and principled when faced with complex situations

    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required

    • Communication – Ability to generate concise, compelling, objective and data-driven reports

    • Teamwork – Working well with others is required in the Fund’s collaborative environment

    • Diversity – Must be capable of working in a culturally diverse environment

    • Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise

    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)



    This position is  responsible for the accurate and timely review, disposition, documentation, and system input of submitted prescription prior-authorization (PA) requests. The Prior Authorization Technician will receive inbound and initiate outbound calls to providers and members. Must be familiar with third party rejects and be able to assist in resolving rejected claims


    • Makes outreach calls to members, providers, and patients to resolve medication issues.
    • Reviews daily reject report and make outreach calls to members and providers.
    • Reviews and resolves all prior authorization emails, questions, and member escalation issues
    • Completes data entry of prior-authorization requests within the systems
    • Receives and reviews prescription prior-authorization requests from contracted providers via telephone, fax, email, or surface mail
    • Provides general PA information requests via telephone, fax, email, or surface mail to providers, members, and/or clients and initiating information requests from providers when additional information is required to adjudicate a prior authorization request
    • Assist pharmacies, if needed, in resolving obstacles for a PA related medication
    • Assists participants with manufacturer or other assistance programs
    • Identifies, reports, and escalates any complaints to immediate manager
    • Assist, as needed, in updating PA criteria in the PA software system
    • Assists the department with escalated pharmacy benefit related participant issues
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job
    • Performs Essential Job Functions and Duties with or without reasonable accommodation



    Years of Experience and Knowledge

    • 1 ~ 2 years of related experience minimum as a pharmacy technician including pharmacy call center experience
    • Experience working in a managed care setting preferred (Pharmacy Benefit Management-PBM)

    • Working knowledge and experience in prior authorization

    • Working knowledge and experience with third party rejects

     Education, Licenses, and Certifications

    • Pharmacy technician license required
    • Preferred: Certification as a Pharmacy Technician

    • High School Diploma or GED

    • Associate's or Bachelor’s degree preferred


    Skills and Abilities

    • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
    • Intermediate level Microsoft Excel skills
    • Intermediate level system(s) skills in using a prior authorization platform (Rx Claims)
    • Preferred fluency (speak and write) in Spanish
    • Strong communication skills (written and verbal)
    • Analytical, problem solving and multi-tasking skills
    • Customer service and team work skills
    • Attention to detail
    • Ability to identify and interpret drug names and uses
    • Collaboration skills
    • Ability to work independently with limited direction
    • Ability to interact with patients, providers, and coworker


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