Pharmacy Technician II

Job Summary:The Pharmacy Technician III is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department. They will also assist leadership in monitoring and oversight of work queues, work distribution, resource building, and process management.Essential Functions:Review prior authorization requests for the member's pharmacy and medical benefit submitted by providersSend fax communications to providers when necessaryContact provider offices to follow up on failed faxesEducate CareSource providers about resources outlining formulary alternativesPlace prior authorizations for when approval is appropriate in the prior authorization system(s)Initiate process for routing prior authorizations requiring review by a pharmacistAnswer calls from providers regarding prior authorization requests prescription coverage and formulary issues in a timely mannerPerform outbound calls to obtain information from providers and/or pharmaciesDocument all telephonic interaction in appropriate system(s)Ensure all methods of inquiries (fax, e-mail, ePA) and submissions are answered with in the state mandated periodInvolvement in special projects reviewed by the management team when neededAnswer calls and troubleshoot issues from retail and specialty pharmaciesAssist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questionsMaintain awareness of current workload aging and respond with appropriate sense of urgencyMaintain knowledge and understanding of all processes and procedures for all markets on faxes and phonesResponsible for taking pharmacy call center inquiries and responding to/resolving pharmacy claim adjudication issuesVerify network status for providers submitting medical benefit prior authorization requestsAble to identify training needsWill utilize self-opportunities for all skill setsAbility to handle and resolve provider complaints in a timely mannerMonitor current processes and suggest changes when neededAdhere to all departmental and company policies and proceduresPerform any other job duties as requestedEducation and Experience:High School Diploma or equivalent is requiredMinimum one (1) year managed care prior authorization experience is requiredMinimum of three (3) years of retail pharmacy or hospital experience is preferredCompetencies, Knowledge and Skills:Computer proficient with knowledge and experience in a

Created: 2025-12-04