Clinical Prior Authorization Technician (Temp, Temp-to-hire)
Capital Rx
Position Responsibilities:
- Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines
- Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review
- Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
- Review and analyze pharmacy claims data for proactive outreach and intervention.
- Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team
- Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
- Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
- Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
- Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment
Required Qualifications:
- 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
- Experience handling prior authorization requests/understanding of prior authorization requirements required
- National Certified Pharmacy Technician (CPhT) license, required
- High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred
- Excellent communication, writing, and organizational skills
- Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
- Ability to multi-task and collaborate in a team with shifting priorities
This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
About Capital Rx
Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.
Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.