G-TECH Jobs

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.

EDUCATION AND/OR EXPERIENCE

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

2. Two (2) years experience in retail or hospital Pharmacy required.

3. Pharmacy Technician Certification (PTCB) preferred

4. Knowledge of prescription drug names, therapeutic classes and claims processing

5. Experience with Medicare Part D prescription benefits may be preferred for some positions

OTHER SKILLS AND ABILITIES

1. Expert knowledge of pharmacy claims processing

2. Understanding of formularies and utilization management edits

3. Familiarity with pharmaceutical manufacturers and product/cost information

4. Computer Literate (Microsoft Office Products).

Category Analyst

Function Information Technology

Req ID JN -092024-121515