Um pharmacy technician

• Reviews prior authorization requests and units for medications requested under the medical benefit
• Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
• Sends notification to members and providers of authorization decisions via telephone, fax, or mail
• Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
• Establishes great rapport with Provider offices via telephonic communication
• Sends request for information sheets to Providers
• Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
• Additional duties as necessary

• High School Diploma or GED from an accredited institution
• Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
• Experience conducting prior authorization reviews
• Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional

• Strong written and verbal communication skills in Chinese, Spanish, or Russian
• Demonstrated critical thinking and problem-solving skills
• Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities
• Knowledge of specialty pharmaceuticals and billing practices in the medical benefit
• Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
• PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
• Experience with TruCare Care Management Platform

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions