ESSENTIAL FUNCTIONS:

·         Participates in prior authorization processing with a full understanding of procedures related to the process and leverages a comprehensive understanding of override process and manipulation of SXC system to produce paid claims.

·         Accountable for the review of prior authorization requests using prior authorization guideline question and answer protocol.

·         Assists with ongoing and special projects related to the prior authorization process. 

·         Assists pharmacies in prior authorization claims processing by giving information needed to process claims (i.e., routing information for a claim, medication information, etc.).

·         Inputs appropriate call tracking notes throughout the prior authorization process and with each call received or made.  Provide outstanding customer service to all inbound/outbound calls.

·         Relays pertinent information to physicians and pharmacies regarding prescription benefits plan, including, but not limited to co-pay information, plan design, medication alternatives.

·         Maintains knowledge of current drug information and industry trends as they pertain to the Pharmacy Benefit Management business.

·         Meets or exceeds departmental performance standards.

·         Follows all policies and procedures relating to job responsibilities.

·         Performs other duties as assigned to meet corporate objectives.

QUALIFICATIONS:

High school diploma or general education degree (GED); current pharmacy technician licensure; and 3+ years experience in pharmacy and/or related PBM business highly preferred.  Knowledge of drug therapies (i.e. generic/brand names, drug classes) and retail pharmacy operations.  Ability to synthesize skills and knowledge while demonstrating a high level of personal and professional responsibility.  Must have strong customer service, communication, computer, and data entry skills.  Demonstrated ability to follow guidelines for accurate data entry while meeting or exceeding performance standards.

**Must be fully bilingual Spanish/English**