Prior Authorization Review Technician

Job Ref: TE0036
Category: Professional
Department: PHARMACY
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $61,904.00 - $61,904.00

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Position Overview: 

The Prior Authorization Review Technician is responsible for inputting, providing notification for and reviewing prior authorization requests. The Prior Authorization Review Technician is also responsible for entering and auditing overrides input in the Pharmacy Adjudication system, answering member inquiries and assisting in all relevant Pharmacy department deliverables.

Work Shifts

9:00AM-5:00PM

Duties & Responsibilities

• Inputs all received medical benefit and pharmacy benefit prior authorization requests into our processing platforms, ensuring accurate transcription of all information
• Reviews and provides recommendations for select prior authorization requests following internal guidelines and criteria for review
• Answer inquiries from, but not limited to, members, providers and pharmacies received from our pharmacy call center line
• Provides verbal notification of prior authorization decision and inputs accurate medication overrides in the pharmacy adjudication platform
• Performs audit of vendor-inputted medication overrides in the pharmacy adjudication platform
• Assists in pharmacy case management activities
• Supports departmental quality initiatives
• Answers all triaged inquiries regarding MetroPlusHealth Pharmacy and Medical Benefit

Minimum Qualifications

• Associate’s degree with 3 years’ experience as a Pharmacy Technician. Bachelor’s degree preferred
• OR High school diploma/GED with 5 years’ experience as a Pharmacy Technician.
• Pharmacy experience in a managed care environment preferred
• Experience in auditing preferred
• Experience in government programs (Medicare, Medicare Part D, and Medicaid) preferred
• Proficiency with MS Word, Excel, and PowerPoint is required.
• Proficiency with MS Access is preferred

Licensure and/or Certification Required:

• Pharmacy Technician Certification Board (PTCB) or ExCPT Pharmacy Technician Certification, required.

Professional Competencies: 

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills