Prior Authorization Specialist
US Tech Solutions
**Duration:** 6 months contract
**Job Description:**
+ The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
**Responsibilities:**
+ Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards.
+ Utilizing multiple software systems to complete Medicare appeals case reviews
+ Meeting or exceeding government mandated timelines
+ Complying with turnaround time, productivity and quality standards
+ Conveying resolution to beneficiary or provider via direct communication and professional correspondence
+ Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
+ Utilizing multiple software systems to complete Medicare appeals case reviews
+ Meeting or exceeding government mandated timelines
+ Complying with turnaround time, productivity and quality standards
+ Conveying resolution to beneficiary or provider via direct communication and professional correspondence
+ Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
+ Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
+ Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
+ Identify and elevate clinical inquiries to the pharmacist team as appropriate
+ Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc.
**Experience:**
+ 0 to 3 years of related work experience.
**Skills:**
+ Prior Authorization
+ Call handling experience.
**Education:**
+ High School diploma or GED
+ Active pharmacy tech license required of the state they resist.
**About US Tech Solutions:**
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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