Description:
This role is responsible for managing the prior authorization fax queue and for the creation of prior authorization cases in a timely manner according to high quality standards. This role will also support special projects according to business needs.

Requirements:

• GED or equivalent
• Active Pharmacy Technician Certification (PTCB) required
• 2+ years of experience in Retail Pharmacy, PBM and/or other managed care organization
• Microsoft Office experience
• Excellent organizational, written and verbal communication
• Highly motivated and good interpersonal skills, self-starter
• Excellent critical thinking skills, detail-oriented
• Ability to adapt and perform duties efficiently whenever unexpected changes arise
• Knowledge of pharmaceutical terminolog

• Triage and technical review of prior authorization faxes.
• Creates prior authorization cases in the portal to include chart notes and/or other relevant clinical information for clinical reviewers to render a decision.
• Research and resolves prior authorization portal inquiries including, eligibility verification, benefits, authorization process, status, and claims questions in a timely, respectful, caring and competent manner.
• Understands the pharmacy benefit plans and accurately interprets the plan information to Client and Member services.
• Respond to prior authorization fax requests and clinical services email, within standard turnaround times and meeting quality standards regulatory requirements.
• Ensure that all departmental goals (including, but not limited to turnaround times, production expectations, and quality metrics) are met.
• Communicate with clinical reviewers on issues related to formulary, non-formulary criteria, or respective policies and procedures.
• Generates letters to members communicating PA outcomes, or if lack of response, will send incomplete request notifications to prescribers.
• Interface with LucyRx’s adjudication system, when necessary to assist with medication processing issues.
• Actively participate in internal quality improvement process enhancements.
• Participate in team training and professional development of prior authorization processing, pharmacy claims, appeals, and any related clinical services issues.
• Attendance and punctuality are essential functions for this position.Performs other duties as assigned.

Requirements:

• GED or equivalent
• Active Pharmacy Technician Certification (PTCB) required
• 2+ years of experience in Retail Pharmacy, PBM and/or other managed care organization
• Microsoft Office experience
• Excellent organizational, written and verbal communication
• Highly motivated and good interpersonal skills, self-starter
• Excellent critical thinking skills, detail-oriented
• Ability to adapt and perform duties efficiently whenever unexpected changes arise
• Knowledge of pharmaceutical terminology

Preferences

• State Board Pharmacy License in any US state
• Bachelor of Arts or Science degree from accredited college

• Strong Microsoft Excel skills preferredProject management skills preferred

• LucyRx is an independent, next-generation pharmacy benefit manager (PBM) redefining prescription care. Fueled by innovation and decades of leadership experience, LucyRx delivers better outcomes through its integrated specialty network, formulary marketplace, and next-day home delivery solutions.
  Powered by its proprietary AI platform, LucyIQ™, the company provides real-time insights that support evidence-based clinical decisions, clear pricing, and exceptional service from U.S.-based pharmacy technicians. Partnering with more than 60,000 pharmacies, LucyRx serves over 1,200 clients nationwide.
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