Prior Authorization Pharmacy Technician - Remote

1w1 week ago

Oscar

Remote · Full-time · $45,140 – $50,160

About this role

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We're hiring a Prior Authorization Pharmacy Technician to join our Pharmacy Tech team. This position processes prior authorization requests and supports escalated issues to improve member and provider experience.

You will use Oscar and vendor tools to determine eligibility, screen required documents, create, process, and track pharmacy prior authorization requests. Collect relevant medical information via telephone, fax, and portal while applying appropriate PA criteria. Clearly document all communication and decision making.

Report to the Pharmacy Technician Supervisor in this remote role open to candidates residing in states like Alabama, Florida, Texas, Georgia, and many others. Complete daily work from your home office with occasional travel for team meetings and company events. Ensure high quality pharmacy decision-making.

Meet required decision-making timeframes and communicate oral and written prior authorization outcomes that comply with standards. Base pay ranges from $17.20 - $22.57 per hour in most locations and $19.11 - $25.08 in California, Connecticut, New Jersey, New York, and Washington. Eligible for employee benefits and 15 days annual vacation accrual.

Requirements

2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience
Active, unrestricted Pharmacy Technician certification (CPhT)
Excellent customer service, phone etiquette, and typing skills
1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager
Experience working with CVS Caremark's portal and criteria
In-depth understanding of how to operationalize step therapy rules and regulations
Strong verbal and written communications, and interpersonal interactions

Responsibilities

Determine eligibility, screen for required documents, create, process, and track pharmacy prior authorization requests using Oscar and vendor tools
Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to requests for additional information
Collect relevant medical information via telephone, fax, and portal and apply appropriate PA criteria, clearly documenting all communication and decision making
Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy
Comply with all applicable laws and regulations
Perform other duties as assigned

Benefits

Base pay of $19.11 - $25.08 per hour in California, Connecticut, New Jersey, New York, and Washington
Base pay of $17.20 - $22.57 per hour in all other locations
Eligible for employee benefits
Monthly vacation accrual at a rate of 15 days per year
Remote position open to candidates in specified states