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Pharmacy Tech - Prior Authorization Experience Preferred
at Health Choice
The Pharmacy Technician processes written and telephone requested services by providers for Health Choice members within established timeframes, following Health Choice criteria and guidelines. This position also completes data entry and provider notification to ensure timely service to members and answers a high volume of calls within contract-mandated timeframes.
Answer prior authorization/pharmacy calls
Review prior authorization requests:
* Review requests based on current medication formulary and Health Choice established guidelines
* If determination is not made, forward PA request to Supervisor/Manager
* Contact referring provider to obtain additional information needed to make determination
* Fax decisions to requesting providers
* Enter appropriate authorizations and notify provider of approval
* Document criteria met in electronic medical record system
* Complete processing within established timeframes
* Process incoming faxes
Assist other departments with Prior Authorization needs:
Assist Utilization Review Nurses with obtaining authorizations and coordinating care for discharge planning, forward appropriate referrals to case management.
* Enter authorizations for nurses for discharge care
* Collaborate with MCH and Behavioral Health staff for pharmacy-related requests
* Assist Member Services with formulary questions and pharmacy requests
* Assist Disputes/Appeals department with pharmacy-related information during appeals process
Provide ongoing education and training to physician’s offices and facilities:
* Inform offices of any updated or changed policies and procedures or changes to the formulary
* Ensure all physicians and facilities are educated on proper authorization procedures as well as new pharmacy guidelines
* Educate providers regarding Medicare benefits
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
High School Diploma / GED
Certified Pharmacy Tech active and good standing in Arizona
Previous Medicaid / Medicare experience
Previous call center experience