Prior Authorization Pharmacy Technician I

Job Description

Job Description

Prior Authorization Pharmacy Technician I

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular onsite presence at the VIVA HEALTH corporate office and some work-from-home opportunities. May require evening and weekend work, as well as overtime when necessary.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health -

Job Description

The Prior Authorization Pharmacy Technician I will process coverage determinations (prior authorization and exception requests) to the Plan formulary. This role receives, researches, documents, and processes the coverage determinations in a timely manner as required by regulatory requirements. This position also communicates decisions with providers, members, and internal staff as directed by management.

Key Responsibilities

• Receive, review, process, and respond to coverage determinations to the Plan formulary in accordance with departmental guidelines and federal regulations.
• Provide support to internal and external customers and serve as a representative for the department both internally and externally.
• Maintain coverage determination policies and procedures and assist with policy and procedure education for customers.
• Responsibilities may require evening and weekend work as well as overtime in response to Centers for Medicare and Medicaid Services (CMS) requirements.

REQUIRED:

• High School Diploma or GED
• Current Pharmacy Technicians License in good standing with the Alabama State Board of Pharmacy
• CPhT (Certified Pharmacy Technician) from the Pharmacy Technician Certification Board or the National Healthcare Association
• Demonstrate excellent customer service skills through written and verbal communication
• Basic computer skills
• Ability to work overtime and share after-hours, holidays, inclement weather, and weekend responsibilities

PREFERRED:

• Bachelor’s Degree or equivalent work experience
• Customer service or call center experience
• Physician office experience
• Health Plan or PBM experience
• Current LPN License in good standing with the State of Alabama Board of Nursing
• Licensed Practical Nurse Certification

Click Here to learn more about how VIVA HEALTH is building a culture where diverse voices, backgrounds, and perspectives are welcomed and celebrated!