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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: Pharmacy Authorization Specialist
Work Location: Lansing, MI 48901
Duration: 2 Months
Job Type: Contract
Work Type: Remote
Job Description
Department: Pharmacy Technician
Engagement Description:
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
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Knowledge of pharmacy claims processing
Understanding of formularies and utilization management edits
Familiarity with Medicare Guidelines and Timeframes
Computer Literate (Microsoft Office Products).
Ability to read and comprehend simple instructions, short correspondence, and memos.
Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
TekWissen Group is an equal opportunity/affirmative action Employer (m/f/d/v) supporting workforce diversity.
Full Time