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PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help customers, doctors and patients use effective medication therapy to improve health and wellness. For more than 15 years, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees - more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians - and in the services we provide.
PerformRx is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies.
*** Candidates must reside in North Carolina. ***
Responsibilities:
Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Prior Authorization Technician I assist in the prior authorization process.
Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner for pharmacy and medical billing. Responsible for making outbound calls/receiving inbound calls, speaking with physicians’ offices for additional information or clarifications needed to process prior authorization request.
Supports the Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered. Recommends course of action for providers where patterns appears outside of guidelines and generally accepted pharmacy standards.
Keeps abreast of industry trends and regulatory changes in the pharmacy industry and incorporates knowledge in the performance of job duties. Identifies problems in process/procedures or services and makes recommendations for improvements. Maintains a balance of productivity, quality and timeliness of job accountabilities. Participates in department self-audit procedures for on-going evaluation of service.
Maintains and updates internal databases. Enters application information, prior authorizations and other relevant data. Ensures database information and appended files are current and accessible to staff. Generates reports and other information requested on a scheduled/as needed basis.
Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.
Performs other related duties as assigned
Attends required training on an annual basis
Adheres to AMFC policies and procedures
*** Must be available to work weekends and holidays. ***
Education/Experience:
Requires:
Full Time
Insurance
$34k-42k (estimate)
10/05/2022
06/28/2023
amerihealthcaritasdc.com
WASHINGTON, DC
100 - 200
2012
FELICIA HUGEE
$10M - $50M
Insurance
The job skills required for Prior Authorization Technician I - Remote include Prior Authorization, Customer Service, Managed Care, Communication Skills, Teamwork, Dedication, etc. Having related job skills and expertise will give you an advantage when applying to be a Prior Authorization Technician I - Remote. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Prior Authorization Technician I - Remote. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Prior Authorization Technician I - Remote positions, which can be used as a reference in future career path planning. As a Prior Authorization Technician I - Remote, it can be promoted into senior positions as an Admitting Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Prior Authorization Technician I - Remote. You can explore the career advancement for a Prior Authorization Technician I - Remote below and select your interested title to get hiring information.