Job Description

Job Description

Job Description

Required Skills & Experience

• 1+ years of experience as a Pharmacy Technician
• High school diploma or GED
• State registered or state certified as a pharmacy tech
  • If in DE, PA, or NY - must have National certification in lieu of state registration (PTCB or NHA)
• Experience with prior authorization, test claims, and claims adjudication

Nice to Have Skills & Experience

• Nationally certified as a CPhT (PTCB or NHA)
• Good time management skills
• Strong collaborator and team player
• Organized problem solver

Job Description
Insight Global is looking for Prior Authorization Technicians to work fully remote in support of one of our large healthcare clients. Within this role, this person will provide patient care by removing the barriers to medication access. Working with insurance companies and clinician offices to facilitate approval of medications through prior authorizations. Working with patients and a variety of funding sources such as foundations, or directly through manufactures to obtain financial assistance for high dollar co-pays. Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims, refill medications, and increase adherence in patients.

Below are the key responsibilities for this role:

• Directly communicate with insurance companies to facilitate the approval of medications.
• Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up.
• Effectively communicate across databases, electronic medical records and emails to document patient concerns, prior authorization status, and financial assistance needs.
• Review prescriptions with doctors' offices to ensure optimal care of the patient.
• Keep complete and accurate records of patient communications.
• Assist patients in the management of their pharmacy insurance claims.
• Work closely with pharmacists and pharmacy liaisons to provide an integrated approach quality patient care.
• Communicate directly with patients over the phone to assist them in all aspects of medication compliance.
• Research and investigate information to enable strategic decision-making by others.
• Manage, organize, and update relevant data using database applications.
• Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards.
• Identify trends, resolve problems; recommend improvements; implement change.
• Actively participate in process improvement initiatives.
• Act as a value-added business partner to stakeholders throughout the organization.
• Protect organization's value by keeping information confidential.
• Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Minimal in or out of state travel may be required.
• Perform other duties as assigned.

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