Prior Authorization Technician Level I

in Lakeland
, FL
Reference: 19-03618


The Prior Authorization Tech I is responsible for processing all administrative prior authorization requests with established standards which includes but is not limited to taking calls from pharmacies, physicians’ offices, and members with the ability to clearly identify the problems, analyze the situation, and rectify concerns while maintaining confidentiality of all PHI. This position requires strong telephone, verbal and written communication skills, knowledge of customer service principles and practices, and time management skills with the ability to multi-task. Individual must also be proficient in Microsoft applications.

Essential Duties and Responsibilities: 

  • Responsible for taking administrative PA calls from pharmacies, physicians’ offices and members with the goal being a first call resolution. These calls with include, but are not limited to refill too soon requests, vacation override requests, claim dollar override requests, DUR, etc.
  • Accountable for placing call notes in the appropriate areas every time a PA request is handled
  • Work closely with pharmacies, providers, and members to resolve any questions or issues involving PA’s
  • Respond in a prompt, professional, and courteous manner to pharmacy, provider and member inquiries regarding administrative prior authorizations
  • Ability to clearly identify problem, analyze situation, and rectify pharmacy, provider, or member concerns using established procedures
  • Ability to handle difficult people and problems by resolving matters in an effective and timely manner
  • Provide support to pharmacies having difficulty processing claims
  • Ensure all PAs are placed into RxClaim correctly and in a timely manner
  • Apply appropriate policies, procedures, and eligibility and benefit policies
  • Maintain confidentiality of all PHI in compliance with state and federal law
  • Consistently meet established productivity, schedule adherence, and quality standards, while maintaining a good attendance record
  • Other duties as assigned

Education and Experience: 

  • Pharmacy Technician Certification required
  • At least 2 years of pharmacy related experience
  • At least 2 years of customer service related experience
  • MS Office Suite knowledge (which includes the ability to learn new and complex computer system applications)

Knowledge, Skills, and Abilities: 

  • Strong telephone, verbal, and written communication skills
  • Knowledge of customer service principles and practices
  • Time management skills
  • Teamwork and team building skills
  • Ability to work independently within team environment with little direct supervision
  • Ability to work in a high-pace, stressful environment
  • Ability to remain focused and productive each day though tasks may be repetitive
  • Strong attention to detail and effective follow-up skills
  • Ability to multi-task
  • Claim system knowledge
  • Positive attitude with excellent customer service mindset demonstrating the organization’s commitment to incredible service
  • Computer proficiency to navigate required databases and operate in required software packages
  • Interested in working with people with a strong desire to help resolve problems
  • Ability to work under pressure
  • Creative problem solver and effective at conflict resolution
  • Ability to sit at a computer using phone and headset for length of shift with breaks and lunch away from desk assigned per length of given shift
  • Demonstrated ability to handle problems tactfully