Pharmacy Prior Authorization Coordinator II
Sentara | |
life insurance, vision insurance, parental leave, paid time off, sick time | |
United States, Florida, Miami | |
April 26, 2024 | |
City/State Doral, FLOverview Work Shift First (Days) (United States of America)AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Pharmacy Prior Authorization Coordinator II in Miami or Gainesville, Florida. This is a hybrid position, 2 days in office and 3 days remote. Scope of the position: Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day-to-day operations for the call center and prior authorization cases for all lines of business (, Medicare, Exchange and Commercial). Essential Job Functions: Minimum Requirements: Preferred Qualifications: Our Benefits Keywords: Talroo-health Plan, #Indeed, Pharmacy Call Center, Authorization experience, Florida Pharmacy Technician or National Certified PTCB Technician Job Summary Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial). Provides knowledgeable and courteous customer service and response to members and providers. Handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution. Uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/ customer care activities that do not require the expertise of a pharmacist.Serves as a resource and mentor to pharmacy staff and assists TC with workflow oversight for the pharmacy call center and prior authorization operational teams. Assists with special projects and assignments and maintains above average knowledge of all pharmacy related applications to assist in workflow performance. Serves as an internal resource interfacing with members, providers, and internal staff to resolve escalated pharmacy claims and prior authorization issues. Owns the effective resolution of member or provider issues, complaints, and inquiries, focusing on high member satisfaction. 2 years of Pharmacy Call Center or Authorization experience required. 2 years of Managed Care, Health Plan or PBM experience preferred. Qualifications: HS - High School Grad or Equivalent Certified Pharmacy Technician (CPhT) - Certifications - Pharmacy Technician Certification Board (PTCB), Pharmacy Technician Certification (CPhT) - Certification - National Healthcareer Association (NHA) Call Center, Managed Care, Pharmacy TechnicianSkills Active Learning, Active Listening, Communication, Learning Strategies, Microsoft Office, Monitoring, Quality Control Analysis, Reading Comprehension, Service Orientation, Time ManagementSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission "to improve health every day," this is a tobacco-free environment. |