[Remote] Pharmacy Technician Customer Service Representative

Note: The job is a remote job and is open to candidates in USA. NTT DATA is a business and technology services company that supports clients through healthcare and technology solutions. The Pharmacy Technician-Customer Service Representative handles member and provider calls, evaluates pharmacy prior authorization requests using clinical criteria, documents decisions, communicates coverage and authorization information, and escalates clinical matters to pharmacists.

Responsibilities

• This position takes in-coming calls from members, providers providing professional phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist
• Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria
• Determines appropriateness for medications
• Communicates decision to physicians, physician’s office staff, medical management staff, and/or pharmacists
• Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician’s office staff, medical management staff, and/or pharmacists
• Research, resolve, and documents prior authorization outcomes in the pharmacy system
• Escalates requests to Pharmacist when request requires extensive clinical review or denial
• Research, resolve, and documents physician or client inquiries and grievances
• Provides verbal or written results to client, prescriber, provider, and/or management
• Performs other duties as required
• Answers questions and resolves issued from members, providers, medical professionals, and plan sponsors
• Triage to staff accordingly
• Document and track contacts with members, providers, and plan sponsors
• Provide notification to members on decisions, changes, or other relevant information
• Communicate coverage, authorization, and eligibility information to member or provider
• Prioritizing and organizing workload in adherence to deadlines
• Ability to multi-task to accomplish workload efficiently

Skills

• 1+ years of experience in Customer Service in a Call Center environment
• 1 + years of prior pharmacy background or healthcare
• 1+ years of experience in a position involving research, problem solving, and timeline responsiveness
• 1+ year of Microsoft Office to include Excel and Word
• High School Diploma or Equivalent
• Sate Registration Certification or National Certification

Benefits

• Remote work arrangement
• Support for personal and professional growth
• Encouragement of learning opportunities

Company Overview

Company H1B Sponsorship