We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our healthcare team.
Location: Rochester, NY
Work Mode: On-site
Role: Prior Authorization Specialist
Job Description:
The Pharmacy Prior Authorization Technician performs functions as permitted by law, including the initial level processing and review of prior authorization requests for both pharmacy and medical specialty drug reviews. These reviews follow pharmacy management drug policies and procedures. This position accurately prepares and interprets cases for UM (utilization management) reviews and determinations.
In addition, the Technician serves as the content expert for the applications used to process these requests and acts as a resource for staff regarding members’ specific contract benefits. This is consistent with health plan products, policies, procedures, and functions such as member services, claims, and the referral/authorization process.
The Technician provides leadership and expertise in the intake area of the prior authorization process for medications processed through the pharmacy or medical benefit and in processing exception/prior authorization requests that follow standard protocols.
Must have:
Physical and Work Environment Requirements:
Ability to work prolonged periods sitting at a workstation and using a computer.
Ability to sit and/or stand for 3+ hours at a time while using a keyboard, mouse, and/or phone.
Work environment includes standard office settings with fluorescent lighting.
Ability to work from a home office for business continuity.
Ability to travel across the Health Plan’s service region for meetings and trainings as needed.
Must be able to hear, understand, and speak clearly on the phone, with or without a headset.
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