Prior Authorization - Pharmacy Technician

Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharm Techs here will assists in the prior authorization process.

• Reviews and approves physician inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria. 

• Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered. Recommends course of action for providers where patterns appears outside of guidelines and generally accepted pharmacy standards.

• Keeps abreast of industry trends and regulatory changes in the pharmacy industry and incorporates knowledge in the performance of job duties. Identifies problems in process/procedures or services and makes recommendations for improvements. Maintains a balance of productivity, quality and timeliness of job accountabilities. Participates in department self-audit procedures for on-going evaluation of service.

• Maintains and updates internal databases. Enters application information, prior authorizations and other relevant data. Ensures database information and appended files are current and accessible to staff. Generates reports and other information requested on a scheduled/as needed basis.

• Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with AMFC employees and clients at all times.

• Performs other related duties as assigned. 

• Attends required training on an annual basis.