"Alerted.org

Duties & Responsibilities:

+ **Reviews prior authorization requests and units for medications requested under the medical benefit**

+ **Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria**

+ **Sends notification to members and providers of authorization decisions via telephone, fax, or mail**

+ **Ensures prior authorization reviews are conducted within timeframes set forth by CMS and//or NYSDOH**

+ **Establishes great rapport with Provider offices via telephonic communication**

+ **Sends request for information sheets to Providers**

+ **Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations**

+ **Additional duties as necessary** **Minimum Qualifications:**

+ **High School Diploma or GED from an accredited institution**

+ **Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing**

+ **Experience conducting prior authorization reviews**

+ **Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional** **Preferred Qualifications:**

+ **Strong written and verbal communication skills in Chinese, Spanish, or Russian**

+ **Demonstrated critical thinking and problem-solving skills**

+ **Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities**

+ **Knowledge of specialty pharmaceuticals and billing practices in the medical benefit**

+ **Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local**

+ **Coverage Determinations**

+ **PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).**

+ **Experience with TruCare Care Management Platform** **Compliance & Regulatory Responsibilities: Noted above** **License//Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing.**

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.