Pharmacy Technician - Prior Authorization Focus

About the role

Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit Manager (PBM) to resolve issues that may arise in the provision of pharmacy services. Processes determination letters and documents decisions using indicated protocol or clinical guidelines. Participates in quality control and/or quality improvement activities. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit Manager (PBM) to resolve issues that may arise in the provision of pharmacy services. Processes determination letters and documents decisions using indicated protocol or clinical guidelines. Participates in quality control and/or quality improvement activities. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift between the hours of 7am - 7pm. This position is eligible for hybrid work after the training period. This role is located at 4101 Percival Road, Columbia, SC 29229. There is the expectation of rotating weekends and holidays as well. What You 'll Do: Receives and builds cases in the various applications for pharmacy authorization requests. Under Pharmacist guidance and per company policies/guidelines and established criteria sets, reviews, evaluates and authorizes approval of pharmacy requests. Requests additional information from providers including confidential medical history and prior drug therapy, in order to properly evaluate the request. Determines appropriateness for medications. Processes determination letters and communicates decision to providers and/or members ensuring timeliness and accuracy. Researches, resolves and documents outcomes in pharmacy system. Communicates selected authorization criteria, pharmacy benefit coverage, formulary alternatives and/or Pharmacy Management program policies and procedures to pharmacy providers, members and internal contacts. Conducts research necessary to make thorough/accurate basis for each determination made. Loads authorization into the system and ensures the clinical determination is documented accurately into the system for all levels of care. Utilizes allocated resources to back up review determinations. Completes all assigned work within established timeliness guidelines. Identifies and makes referrals to appropriate staff (Pharmacist, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Escalates requests to Pharmacist when request requires extensive clinical review. Establishes and maintains effective relationships with providers, members and internal contacts. Responds appropriately to inquiries received from providers, members and internal contacts. Researches and resolves issues using the appropriate reference material. Participates in quality control and/or quality improvement activities in support of the corporate and team-based objectives. Participates in all Required Licenses and Certificates. To Qualify F or This Position, You'll Need T he Following: Required Education: High School Diploma or equivalent Required Work Experience: 3 years pharmacy technician experience. Required Skills and Abilities: Working knowledge of pharmaceutical claims, language, drug usage and generic substitution practices. Good judgment. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Attention to detail and the ability to handle multiple demands and balance multiple priorities in a fast-paced environment. Ability to remain in a stationary position and operate a computer. Required Software and Other Tools: Microsoft Office. Required Licenses and Certificates: Registered Pharmacy Technician with the

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