Role and Responsibilities
The Clinical Prior Authorization Technician works under the supervision of clinical pharmacists in performing daily activities to support clinical pharmacy initiatives including the prior authorization review process, maintenance of the prior authorization management solution, as well as additional administrative and project-related functions within the Clinical Department while maintaining a balance of productivity, quality, and timeliness of job accountabilities.Initiate and coordinate prior authorization requests and work within the assigned queue(s) in the automated prior authorization systemDetermines appropriateness for medications by providing medical/pharmacy prior authorization review and appeals to ensure timely, accurate responses.Act as a liaison between the Clinical Department and members, providers, pharmacies, and internal departments and respond to inquiries regarding status of prior authorization requests.Researches, resolves, and documents prior authorization outcomes in the automate prior authorization system.Interprets prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to provide a determination for prior authorization.Escalates requests to the Clinical Pharmacist when request requires extensive clinical review or denial.Researches, resolves, and documents physician or client inquires and grievances and provides verbal or written results to the client, prescriber, provider and/or management.Assist with internal and external reporting requests and summarize internal program statisticsExecute reporting matrix of key prior authorization metrics for presentation to department and management upon request.Develop and maintain departmental desk-level procedures, training materials, and related documentation. Train on prior authorization management system updates as directed.Performs other duties as assigned by the manager.Abide by all obligations under HIPAA related to Protected Health Information (PHI).If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without noticeRequired Skills and Competencies
At least two (2) years of pharmacy prior authorization experienceMust be flexible and enjoy working in a fast pace, team-oriented environment with interpersonal skillsEducation: GED or High School Diplomat RequiredLicensure and Certification: Certified Pharmacy Technician (CPhT)Excellent verbal and written communication and computer skillsProficiency in pharmacy computerized systems and software applications, as well as MS Office Product SuiteAbility to follow clinical criteria and instructions to make a determination on prior authorization requestsAbility to identify and trouble-shoot problematic issuesSupervisory ResponsibilityNo Supervisory ResponsibilityPosition Type and Expected Hours of Work
Full-time/Salaried/Exempt.Some flexibility in hours is allowed, but the employee must be available during the core work hours of 8:00AM to 5:00PM CT. We cover clients from West to East Coast, work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends and holidays pursuant with industry demandsTravel
Little to no travel is expected for this position.Required Education and Experience
2 years of pharmacy prior authorization experienceLicensures and Certification: Certified Pharmacy Technician (CPhT)Liviniti, LLC and all entities provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Liviniti expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/V/DPI855c1d626387-26289-34585985