Our Client, a Healthcare company, is looking for a Pharmacy Prior Authorization Technician for their Rochester, NY location.
Responsibilities:
- Conducts an initial level medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the member’s benefit.
- Routes cases directly to the pharmacist/medical director for final determination, as directed.
- Issues verbal and written member notification as required.
- Reviews and interprets prescription and medical benefit coverage across all lines of business including Medicare D to determine what type of prior authorization review is required, documents any relevant medication history and missing information to assist the pharmacist/nurse/physician in the review process.
- Develops and implements process improvement to increase efficiency in the review process for the clinical staff.