Prior Authorization Review Pharmacy Technician Job at NYC Health Hospitals in Ne

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewThe 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.Job DescriptionInputs all received medical benefit and pharmacy benefit prior authorization requests into our processing platforms, ensuring accurate transcription of all informationReviews and provides recommendations for select prior authorization requests following internal guidelines and criteria for reviewAnswer inquiries from, but not limited to, members, providers and pharmacies received from our pharmacy call center lineProvides verbal notification of prior authorization decision and inputs accurate medication overrides in the pharmacy adjudication platformPerforms audit of vendor-inputted medication overrides in the pharmacy adjudication platformAssists in pharmacy case management activitiesSupports departmental quality initiativesAnswers all triaged inquiries regarding MetroPlusHealth Pharmacy and Medical BenefitMinimum QualificationsAssociate's degree with four years' experience as a Pharmacy Technician required orA satisfactory equivalent combination of education, training, and experiencePharmacy experience in a managed care environment preferredExperience in auditing preferredExperience in government programs (Medicare, Medicare Part D, and Medicaid) preferredProficiency with MS Word, Excel, and PowerPoint is required. Proficiency with MS Access is preferred.Licensure and/or Certification Required: PTCB or ExCPT Pharmacy Technician Certification, requiredProfessional Competencies: Integrity and TrustCustomer FocusFunctional/Technical SkillsPosition requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills