Lead Prior-Authorization Technician

3811 N Fairfax
3811 N Fairfax Drive
Arlington, VA 22203, USA

To lead the development and coordination of the prior authorization team as they serve the GWMFA providers. Serve as a member of the Specialty Pharmacy team.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.

Under the supervision of a licensed Pharmacist:

• Maintain effective onboarding and training procedures for team members
• Perform continuous quality improvement of prior authorization and pharmacy-initiated refill program
• Manage time and attendance, payroll, and PTO requests for the team
• Initiate prior authorizations for medications and work with providers on completion
• Confirm patient demographics are accurate and insurance information is correct
• Communicate with the clinical team and patients about prior authorization and refill status and provide updates accordingly
• Identify patient foundation assistance and manufacturer copay assistance programs
• Follow up with the pharmacy to ensure the medication is in process after approval was received
• Process prior authorization renewals
• Work with the provider to resolve prior authorization peer-to-peer reviews and denials
• Transcription of new prescriptions to patient profile
• Ensure correct third-party adjudication of specialty medications
• Communicate with nurses and patients about prescription order status and provide updates accordingly
• Communicate copays with patients before ordering medications
• Make sure that specialty medications with existing PAR levels are appropriately stocked
• Notify the patient when medication is available for pickup and/or schedule delivery
• Basic familiarity with proper medication dosing, use, and required monitoring parameters for specialty medications
• Perform refill reminders for patients on specialty medications and follow up with the prescriber if out of refills
• File all completed prescriptions in accordance with department standards
• At all times, maintain a courteous interaction with patients, visitors, departments, and medical personnel
• Compliance with all established personnel and departmental policies
• Preparation of prescriptions for pharmacist’s review, following federal and local regulations (including labeling)
• Refer issues that require professional judgment to a pharmacist for follow-up

Education

• High school diploma or an equivalent combination of training and experience.

Licensure

• Current and valid licensure as a Pharmacy Technician in the District of Columbia.

Experience

• A minimum of 2 years of verified Pharmacy Technician experience in a retail, nursing home, medical center, or hospital pharmacy

Physical Requirements

• Stand, walk, bend, twist, and reach for long periods of time in a clinical setting.
• Must be able to occasionally lift or carry and push or pull up to 100 lbs. as part of the role
• Regularly exposed to healthcare settings that may require personal protective equipment
• Requires manual dexterity to operate a computer keyboard, calculator, copier machine, and other equipment.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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