Pharmacy Technician – Prior Authorization

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Manage prior authorization requests received via phone, fax, or electronic means.

• Utilize computer resources, existing criteria, and medication guidelines to conduct clinical research for prior authorization evaluations.

• Finalize prior authorization approvals and denials that are approaching expiration.

• Ensure documentation is complete, timely, and accurate.

• Evaluate potential denial language for prior authorizations to ensure compliance with NCQA standards.

• Adhere to prior authorization workflows, policies, and procedures.

• Handle a high volume of inquiry calls related to prior authorizations from provider offices, pharmacies, members, and internal stakeholders.

• Communicate the status or decisions regarding prior authorizations using computer resources.

• Maintain a balance between productivity, quality, and timeliness.

• Engage in required training, continuing education, and team or departmental meetings.

• Work scheduled 8-hour shifts within the operational hours of Aetna Pharmacy Prior Authorization.

• Pronounce medication names and diagnoses, understand medical terminology, and navigate various computer resources.

• Uphold excellent attendance standards.

• Collaborate with a team schedule that may include weekends, holidays, and extended hours.

⛳️ Requirements

• National Pharmacy Technician certification and state licensure or applicable state Pharmacy Technician license, current and in good standing, required and must be maintained.

• 0-5+ years of experience as a Pharmacy Technician.

• Capacity to multitask and prioritize tasks effectively.

• Flexibility to adapt to business or departmental needs.

• Strong organizational skills.

• Reliable home internet access with a minimum download speed of 100mbps, hard wired with an Ethernet cord.

• Dedicated workspace/office area within the home.

• High proficiency in working with a PC and navigating multiple systems and screens.

• Availability to work 40 hours per week, including weekends and holidays.

• Willingness to work extended hours when needed.

• A rotating weekend schedule may be required.

• High School diploma or G.E.D. is required.

• Retail or Hospital experience is preferred.

• Experience with Prior Authorization processing is preferred.

• Claims processing experience is preferred.

• Background in Managed Care, Medicare, and/or Medicaid is preferred.

• AS400 experience is preferred.

• Proficiency in using computerized resources and software applications is preferred.

• Familiarity with Microsoft applications (Excel, Word, and Outlook) is preferred.

• Knowledge of pharmacy practices and procedures, along with the ability to read and comprehend clinical information, is preferred.

• Working knowledge of drug dosage forms, strengths, and equivalents for generic and brand names is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.