Pharmacy Prior Authorization Technician

Innova Solutions is immediately hiring for a Pharmacy Technician. Position type: Full-time Contract Duration: 12 months Location: Buffalo, NY As a Pharmacy Technician, you will be: Conducting an initial level medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the member's benefit. Routing cases directly to the pharmacist/medical director for final determination, as directed. Issues verbal and written member notification as required. Reviewing and interpreting prescription and medical benefit coverage across all lines of business including Medicare D to determine what type of prior authorization review is required, documents any relevant medication history and missing information to assist the pharmacist/nurse/physician in the review process. Developing and implementing process improvement to increase efficiency in the review process for the clinical staff. Working with requesting providers, clinical pharmacists, and other internal staff, as appropriate, in determining whether specific case presentation meets the criteria for approval according to the medical or prescription drug policy and specific coverage criteria. Contacting pharmacies and physician offices as necessary to obtain clarification on prior authorization requests and drugs being billed through the point-of-sale system and/or medical claim system to optimize the member experience. Acting as a lead troubleshooter for the pharmacy help desk, customer care and claim processors to coordinate pharmacy and/or medical claims with prior authorization information on file or needed for the member. Responsible for assuring appropriate auth entry across all lines of business. Ensure care management system interfaces to claim processing system for claim payment. Manual manipulation of auth may be required upon case completion. Performing system testing as required for upgrades and enhancements to the care management system. Acting as a content expert for prior authorization intake for our customers, both internal and external. Serving as department subject matter expert for pharmacy and medical drug authorizations and coverage. Serving as lead liaison for the prior authorization process and its interface to the pharmacy and medical claim systems to troubleshoot. Triages issues to the appropriate department for resolution. Responsible for triages prior authorization workflow daily by rerouting cases, alerting clinical staff of time frame deadlines, monitoring work queues and keeping management aware of issues related to compliance mandated time frames for review completion. Providing phone coverage for incoming calls as required to support the UM process. Including authorization inquiries and information requests, claim inquiries, and other related inquiries. Provides friendly, accurate and timely assistance. Supporting medical and pharmacy drug pricing questions, and uses drug lookup tools such as government sites, and other online resources. Maintaining thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff with related inquiries. Performing unit specific workflow processes consistent with corporate medical & administrative policies, employer specific guidelines, and/or regulatory agencies. Producing, recording, or distributing information for others. On a periodic basis, tracks and reports department performance against benchmarks. Participating in interdepartmental coordination and communication to ensure delivery of consistent and quality health care services examples include Utilization Management, Quality Management and Case Management. Producing at minimum the team average medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the member's benefit. Responsible for demonstrating high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. The ideal candidate will have: High school diploma with a minimum of two years' experience in health-related field is required. Associates degree preferred. Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist background strongly preferred. Utilization management background strongly preferred. Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible. Thank you! Gangotri Chakraborty Associate Recruiter PAY RANGE AND BENEFITS: Pay Range: $22- $25 per hour. *Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc. Benefits: Innova Solutions offers benefits(based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP). ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields. Recent Recognitions: One of Largest IT Consulting Staffing firms in the USA - Recognized as #4 by Staffing Industry Analysts (SIA 2022) ClearlyRated® Client Diamond Award Winner (2020) One of the Largest Certified MBE Companies in the NMSDC Network (2022) Advanced Tier Services partner with AWS and Gold with MS Website: https://www.innovasolutions.com/ Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b. The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws. American Cybersystems, Inc is acting as an Employment Agency in relation to this vacancy.