Sr Prescription Benefit Prior Authorization Technician Specialty

Requirements

• Level 1:
• 3 years pharmacy benefit or prescription claims experience
• 1 year prior authorization experience
• 1 year experience with BCBSAZ PBM system
• 2 years handling confidential information
• Level 2:
• 2 years prior authorization experience
• 3 years handling confidential information
• Level 3:
• 5 years pharmacy benefit or prescription claims experience
• 3 years prior authorization experience
• 2 years experience with BCBSAZ PBM system
• 1 year experience with medical and pharmacy claims systems
• 4 years handling confidential information
• Level 4:
• 12 years pharmacy benefit or prescription claims experience
• 10 years prior authorization experience
• 3 years experience with BCBSAZ PBM system
• 2 years experience with medical and pharmacy claims systems
• 10 years handling confidential information
• ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
• Process prior authorization reviews including intake, clarification, approvals, denials, exclusions, and exceptions
• Meet standard, urgent, and expedited turnaround times for requests
• Respond to internal and external inquiries regarding prior authorization and benefit clarifications
• Participate in projects supporting prescription benefit improvements
• Support audits, reporting, and quality initiatives
• Maintain knowledge of systems, procedures, and guidelines
• Meet department production and quality metrics
• Work full-time schedule (minimum 40 hours per week)
• Perform other duties as assigned
• Level 2 Additional Responsibilities:
• Provide recommendations to pharmacists based on benefit plan design and guidelines
• Assist in improving quality and performance standards
• Communicate recommendations regarding authorization decisions
• Level 3 Additional Responsibilities:
• Provide recommendations based on pharmacy and medical guidelines
• Process specialty medication reviews
• Maintain knowledge of pharmacy and medical claims systems
• Serve as subject matter expert for specialty prior authorization
• COMPETENCIES
• Required Skills :
• Intermediate PC proficiency (w

Benefits

Additional Information

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. PURPOSE OF THE JOB Responsible for internal and external support functions that contribute to accurate claim processing for medications. Processes medication prior authorization requests from providers and answers incoming phone calls related to escalated issues and prior authorization clarifications. REQUIRED QUALIFICATIONS Education: High School Diploma or GED Licenses: Must obtain and maintain an Arizona State Board Pharmacy Technician license within 9 months of hire. Certifications: Must obtain and maintain a Pharmacy Technician Certification Board (PTCB) certification within 9 months of hire. Work Experience: Level 1: 1 year experience in pharmacy or medical field Level 2: 2 years experience in pharmacy or medical field 1 year experience in prior authorization intake and processing Level 3: 3 years experience in pharmacy or medical field 2 years experience in prior authorization intake and processing 1 year experience with specialty pharmacy or medical reviews Level 4: 10 years experience in pharmacy or medical field 4 years experience in prior authorization intake and processing 2 years experience with specialty pharmacy or medical reviews

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