G-TECH Jobs

Support providers (pharmacists and physicians) with Commercial pharmacy/ specialty drug benefits analysis, drug coverage inquiries and prior authorization

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. Answer telephones in an efficient and timely manner to lend appropriate assistance to providers

2. Triage prior authorization requests under the supervision of a Clinical Pharmacist.

3. Assists in maintaining pharmacy prior authorization criteria used in the adjudication of pharmacy/specialty claims.

4. Analyzing written inquiries which lends to entry and updating of pharmacy authorizations into the claims system.

5. Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool.

6. Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.

7. Assist with internal control systems and regulations compliance.

8. Perform other related duties as assigned.

Top 3 Required Skills/Experience –

• 2 years retail pharmacy experience

• Knowledge of adjudicating pharmacy claims

• Computer Literate (Microsoft Office Products)

Required Skills/Experience – The rest of the required skills/experience. Include:

• Two (2) years experience in retail Pharmacy required.

• Knowledge of prescription drug names, therapeutic classes and claims processing

• Expert knowledge of pharmacy claims processing

Education/Certifications – Include:

• High School Graduate of GED equivalent required. Two (2) years of college preferred

• Pharmacy Technician Certification (PTCB) preferred

Category Analyst

Function Information Technology

Req ID JN -022023-119706