Posted on: July 18, 2021
Open to candidates Nationwide - - The Prior Authorization
Technician I assists in the prior authorization process. - An
active/current national Pharmacy Technician certification (i.e.,
ExCPT, NCCT, PTCB) is required.
Your career starts now. We’re looking for the next generation of
health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get
care, stay well and build healthy communities. As one of the
nation's leaders in health care solutions, we offer our associates
the opportunity to impact the lives of millions of people through
our national footprint of products, services and award-winning
programs. AmeriHealth Caritas is seeking talented, passionate
individuals to join our team. Together we can build healthier
communities. If you want to make a difference, we’d like to hear
Headquartered in Philadelphia, AmeriHealth Caritas is a
mission-driven organization with more than 30 years of experience.
We deliver comprehensive, outcomes-driven care to those who need it
most. We offer integrated managed care products, pharmaceutical
benefit management and specialty pharmacy services, behavioral
health services, and other administrative services. Discover more
about us at www.amerihealthcaritas.com.
PerformRxis 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.
PerformRxis 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.
Under the general supervision of
the Supervisor of Pharmacy Prior Authorization Technicians, the
Prior Authorization Technician I assists in the prior authorization
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
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
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
Attends required training on an
Adheres to AMFC policies and
*** Must be available to work
weekends and holidays. ***
*** Multiple shift times
available between the hours of 8:00 a.m. EST to 9:00 p.m. EST.
High School Diploma or
Pharmacy Technician Certification (i.e., ExCPT, NCCT, PTCB) or
ability to obtain one within the first twelve (12) months of
Benefit Manager (PBM), managed care, hospital pharmacy, long-term
care (LTC) pharmacy, home infusion pharmacy, and/or retail pharmacy
Knowledge in pharmacy practices,
procedures and precedents; ability to read and understand
Working knowledge of drug dosage
forms, drug strength, generic & trade name equivalent
Demonstrates knowledge of
Federal & State laws/regulations regarding provisions of
Strong knowledge in specialty
Ability to multi-task and
Ability to comprehend and follow
established office routines, policies and procedures
Customer service and
Ability to adjust based on
Demonstrated courteous and
Proficient PC skills in a
windows based environment
Ability to identify problems
including complex issues and determine solutions, both
independently or in a team/group setting
Must be organized,
detail-oriented and have excellent communication skills (listening,
verbal, written, grammar)
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