What are the responsibilities and job description for the Clinical Prior Authorization Technician position at Serve You Rx?
Description
Are you looking for a positive workplace culture, a training program that prepares you for success, and the career advancement opportunities that allow you to shine? Serve You Rx is looking for a Clinical Prior Authorization Technician to provide administrative support to the Prior Authorization team for clinical pharmacy initiatives including the prior authorization review process and other administrative and project-related functions within the Clinical Department.
Serve You Rx offers clinical services and strategies designed to manage drug costs, ensure appropriate drug use, and improve member outcomes. This position plays a key role in supporting Serve You Rx in reaching its mission to help clients and members have a cost efficient and money-saving way to get the prescriptions they need.
What You’ll Do
As the Clinical Prior Authorization Technician I, you will:
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
The company offers generous benefits to include: medical (HMO and PPO), dental, vision, 401k, HSA, identity theft and legal coverage, pet insurance, paid parental leave, and 18 days of paid time off in your first year.
About The Organization
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
Are you looking for a positive workplace culture, a training program that prepares you for success, and the career advancement opportunities that allow you to shine? Serve You Rx is looking for a Clinical Prior Authorization Technician to provide administrative support to the Prior Authorization team for clinical pharmacy initiatives including the prior authorization review process and other administrative and project-related functions within the Clinical Department.
Serve You Rx offers clinical services and strategies designed to manage drug costs, ensure appropriate drug use, and improve member outcomes. This position plays a key role in supporting Serve You Rx in reaching its mission to help clients and members have a cost efficient and money-saving way to get the prescriptions they need.
What You’ll Do
As the Clinical Prior Authorization Technician I, you will:
- Enter new PA data into the PA system such as patient, provider, and drug information.
- Process PA renewal requests by matching existing patient data with system data for clinical review.
- Monitor PA cases for response, send follow-up requests for information, troubleshoot failed faxes, contact prescriber offices via outbound call and other means, while adhering to HIPAA guidelines and other policies and procedures.
- Sort and assign PA requests (faxes, emails, etc.) for clinical case analysis, direct to assigned clinical staff.
- Accurately work assigned queues and fulfil other responsibilities within the PA management solution.
- Review rejection reports to proactively managing clinical interventions.
- Enter patient information into the requisite database as a part of new enrollments under the alternative funding program.
- Use the Internet, telephone, and other means to research alternative funding sources for medications not covered by the plan.
- Assist with maintaining reference materials about alternative funding availability and eligibility requirements.
- Communicate effectively with patients, prescriber’s offices, and third-party payers about plan design, coverage requirements, and clinical programs.
- Adhere to federal, state, and company rules and regulations related to security of paper and electronic patient health information (PHI)
- Process mail merges and prepare outgoing mail.
- Place overrides into the requisite database as approved by the clinical team or client.
- Perform other duties as assigned.
- High school diploma or GED.
- Minimum of one year of previous administrative experience in a related field to include employee benefits and/or pharmacy/prescription drugs, or similar experience.
- Minimum of one year of medical terminology or prior authorization experience preferred.
- Previous computer experience and basic Microsoft Office Professional experience preferred.
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
The company offers generous benefits to include: medical (HMO and PPO), dental, vision, 401k, HSA, identity theft and legal coverage, pet insurance, paid parental leave, and 18 days of paid time off in your first year.
About The Organization
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.