Tech I - Prior Authorization

Job Responsibilities:

• The Tech I will also assist with other duties such as outbound calls, monitoring / responding to inquiries in mailboxes and other duties as assigned by the leadership team.
• Effectively manage work volume by handling inbound calls / fax requests utilizing appropriate courteous and professional behaviour based upon established standards.
• Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
• This position takes in-coming calls from members, providers, etc. providing professional phone assistance to all callers through the criteria based prior authorization process.
• Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.

 

Duties:

• Analyse clinical algorithms and provide decisions regarding PA Requests.
• Use of online databases and other resources to document appropriate recommendations, clinical decisions and responses.
• Provide ongoing education on the PA Program to healthcare providers and internal partners.
• Deliver the highest quality customer service to healthcare providers and internal providers in a high paced dedicated PA program.
• Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers).
• Excellent communication skills (oral, written, grammar, listening).
• PC Windows experience required.
• Ability to maintain confidentiality.

Shift Times:

• 8.00 AM TO 4.30 PM

 

Training Information:

• Training During Day from 9/29 - 10/10 (Monday - Friday)
• Shift: 6:00AM - 2:30PM

 

 Experience / Education:

• Minimum three years’ experience required in a customer service position with high volume call centre experience
• Preferably in healthcare, social services, or a similar service position.
• Prior Authorization requires a cpht for the role along with a High School Diploma or GED.

All your information will be kept confidential according to EEO guidelines.