Prior Authorization Specialist

Overview:

Tek Wissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Prior Authorization Specialist

Work Location: Lansing, MI 48901

Duration: 2 Months

Job Type: Contract

Work Type: Remote

Job Description

Department: Pharmacy Technician

Engagement Description:

• Support Client and BCNA providers (pharmacists and physicians) with Medicare Part D drug coverage inquiries, Grievances, and prior authorizations.

RESPONSIBILITIES/TASKS:

• Answer telephones in an efficient and timely manner to lend appropriate assistance to providers Process prior authorization requests under the supervision of a Clinical Pharmacist.

• Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests.

• Analyzing written, faxed, and verbal inquiries which leads to entry of pharmacy authorizations into the system.

• Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool. Troubleshoot problems, inquiries, and new processing procedures for coverage determinations. Perform other related duties as assigned.

• This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:

• High School Graduate of GED equivalent required. Two (2) years of college preferred.
  

EXPERIENCE:

• Two (2) years' experience in retail or hospital Pharmacy required. Pharmacy Technician Certification (PTCB) preferred Knowledge of prescription drug names, therapeutic classes and claims processing Experience with Medicare Part D prescription benefits may be preferred for some positions

TekWissen Group is an equal opportunity/affirmative action Employer (m/f/d/v) supporting workforce diversity.