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Job Type
Full Time
Job Details
The Pharmacy Technician position is a dynamic position responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The Pharmacy Technician is responsible for approval decisions/denial recommendations based on predetermined clinical criteria, updates to units requested, decision notification for members and providers, establishing good rapport with Provider offices, strong communication and customer service skills. The Pharmacy Technician position is part of multidisciplinary team and will work closely with Providers, Pharmacists, and Medical Directors. The Pharmacy Technician will report to the Clinical Pharmacist. Duties & Responsibilities:Review prior authorization requests and units for medications requested under the medical benefitAssess provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteriaTelephonic/ fax/ mail notification to members and providers of authorization decisionsEnsure prior authorization reviews are conducted in time-frames set forth by CMS and/or NYSDOHEstablish great rapport with Provider offices via telephonic communicationSend Providers request for information sheetsEnsure that patient information is always shared appropriately maintaining confidentiality and compliance with federal/HIPAA regulationsAdditional duties as assignedMinimum Qualifications:Pharmacy Technician with active national Pharmacy Technician Certification Board (PTCB) certificate or active Pharmacy Technician License in the state of New YorkMinimum of 1 year experience conducting prior authorization reviewsStrong clinical backgroundStrong written and verbal communication skills in EnglishDemonstrated critical thinking and problem-solving skillsTeam player with a passion for learning and interest in growing skills in a dynamic environment with various opportunitiesStrong telephonic communication skillsPreferred Qualifications:Strong written and verbal communication skills in Chinese, Spanish, or RussianKnowledge of specialty pharmaceuticals and billing practices in the medical benefitKnowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage DeterminationsPC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).Experience with TruCare Care Management PlatformLicense or Certification: Certified Pharmacy Technician in the state of NY in good standing.Regulatory or Compliance activities:Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to 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. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*:
- Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
- All Other Locations (within approved locations): $41,101 - $60,320
About the Company
Healthfirst, Inc.
New York City, NY, United States
Healthfirst is one of the nation’s largest not-for-profit health insurers, offering members access to high-quality, affordable healthcare. The... Read more