• Pharmacy Prior Authorization Technician

    Job Locations US-IL-Aurora
    Posted Date 3 months ago(3/13/2019 5:09 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 schedule for this position will be from mid-morning to the evening (between the hours of 9:00 am to 7:00 pm).

    • Receives and reviews prescription prior authorization requests from contracted providers via telephone, fax, email, or surface mail
    • Provides general prior authorization information requests via telephone, fax, email, or surface mail to providers, members, and/or clients and initiates information requests from providers when additional information is required
    • Assists pharmacies in resolving obstacles for a prior authorization related medication
    • Assists members with manufacturer or other assistance programs
    • Provides accurate and timely data entry of prior authorization requests within the systems
    • Identifies, reports, and escalates any complaints to immediate manager
    • Assists in updating prior authorization criteria in the software system
    • Assists the department with escalated pharmacy benefit related participant issues
    • Assists with ongoing pharmacy department projects and programs
    • Set goals and achieve measurable results
    • Contributes ideas to plans and achieving department goals
    • 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

    • 0 ~ 2 years patient customer service experience minimum
    • Working knowledge and experience as a pharmacy technician or equivalent health care delivery experience including pharmacy call center experience preferred
    • Working knowledge and experience in prior authorization within a managed care organization preferred
    • Working knowledge and experience with third party rejects and resolving rejected claims
    • Experience with third party medical/prescription payment and/or claims adjudication systems

     Education, Licenses, and Certifications

    • High School diploma or GED
    • Required: Certification as a Certified Pharmacy Technician (CPhT)
    • Preferred fluency (speak and write) in Spanish


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