Tech I - Prior Authorization

Job Responsibilities:

The Tech I will also assist with other duties such as outbound calls, monitoring / responding to inquiries in mailboxes and other duties as assigned by the leadership team.
Effectively manage work volume by handling inbound calls / fax requests utilizing appropriate courteous and professional behaviour based upon established standards.
Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
This position takes in-coming calls from members, providers, etc. providing professional phone assistance to all callers through the criteria based prior authorization process.
Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.

Duties:

Analyse clinical algorithms and provide decisions regarding PA Requests.
Use of online databases and other resources to document appropriate recommendations, clinical decisions and responses.
Provide ongoing education on the PA Program to healthcare providers and internal partners.
Deliver the highest quality customer service to healthcare providers and internal providers in a high paced dedicated PA program.
Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers).
Excellent communication skills (oral, written, grammar, listening).
PC Windows experience required.
Ability to maintain confidentiality.

Shift Times:

Training Information:

Experience / Education:

Minimum three years’ experience required in a customer service position with high volume call centre experience
Preferably in healthcare, social services, or a similar service position.
Prior Authorization requires a cpht for the role along with a High School Diploma or GED.

All your information will be kept confidential according to EEO guidelines.

See also