Remote

Pharmacy Prior Authorization Coordinator I

Sentara
life insurance, paid time off, tuition reimbursement, 401(k), 403(b)
United States, Virginia, Virginia Beach
Dec 21, 2024
City/State Richmond, VA Overview Work Shift Swing Shift (United States of America) Sentara Health is currently recruiting for aFull-Time, Remote Pharmacy Prior Authorization Coordinator in Richmond or Tidewater, VA area. Under the direct supervision of a Pharmacy Team Coordinator, the pharmacy prior authorization coordinator (PAC) is responsible for supporting the Pharmacy Department's day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial). This position handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution. The PAC also uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist. The position will be an internal resource interfacing with members, providers, and internal departments' personnel to resolve pharmacy claims and prior authorization issues. Job Requirements High School Grad or Equivalent Certified Pharmacy Technician (CPhT) NHA Pharmacy Technician Certification (CPhT) Pharmacy Technician 1 year required Pharmacy Call Center or Authorization experience preferred Managed Care, Health Plan or PBM experience preferred State Registration required based on location, VA or NC Benefits: Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more. Sentara recognizes our employees by offering: Comprehensive health care plans Generous paid annual leave 401a/401k/403b plan Long and short-term disability Tuition Reimbursement Flex spending and life insurance You can expect employee recognition, performance rewards, plus countless services and programs to enhance work/life balance Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day, join the Sentara Team! Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. keywords: pharmacy technician, managed care, health plan, Indeed, Monster Job Summary Under the direct supervision of a Pharmacy Team Coordinator, the pharmacy prior authorization coordinator (PAC) is responsible for supporting the Pharmacy Department's day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial). At a minimum, the PAC provides knowledgeable and courteous customer service and response to members and providers. This position handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution. The PAC also uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist. This position will be an internal resource interfacing with members, providers, and internal departments' personnel to resolve pharmacy claims and prior authorization issues.The Pharmacy Prior Authorization Coordinator will be able to accept ownership for effectively solving member or provider issues, complaints, and inquiries, keeping member satisfaction at the core of every decision and behavior. Qualifications: HS - High School Grad or Equivalent Certified Pharmacy Technician (CPhT) - Certifications - Pharmacy Technician Certification Board (PTCB), Pharmacy Technician Certification (CPhT) - Certification - National Healthcareer Association (NHA) Call Center, Managed Care, Pharmacy Technician Skills Active Learning, Active Listening, Communication, Learning Strategies, Microsoft Office, Monitoring, Quality Control Analysis, Reading Comprehension, Service Orientation, Time Management Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission "to improve health every day," this is a tobacco-free environment.