SXC is a leader in delivering an innovative mix of technology, critical capabilities and pharmacy benefit services to a wide variety of healthcare payor organizations. . 

• PBMI’s 2009 Rx Benefit Innovation Award.
• Number 8^th on Crain’s Chicago business 2007 fast fifty list.

Responsibilities:

Summary:

The Prior Authorization Specialist is responsible for the accurate and timely review, disposition, documentation, and system input of submitted prescription prior-authorization (PA) requests. The Prior-Authorization Representative will receive inbound and initiate outbound calls to providers and members.

Essential Job Functions:

• Ability to work cooperatively in a team environment.
• Associate will work with the team members to meet SXC's PA client’s needs. 
• Responsible for receiving and reviewing prescription prior-authorization requests from contracted providers via telephone, fax email, or surface mail.
• Responsible for providing general PA information requests via telephone, fax, email, or surface mail to providers, members, and/or clients and initiating information requests from providers when add ional information is required to adjudicate a prior authorization request.
• Assist pharmacies if needed in resolving daily processing obstacles for a PA related medication. Problem solving and the ability to communicate solutions are essential. Responsible for accurate and timely dada entry of prior-authorization requests within the CFS and RxClaim systems.
• Identified, reports, and escalates any complaints to immediate manager.
• Maintains the confidentiality of protected member medical information.
• Reviews, enters and documents prior authorization requests in the claims processing and prior authorization tracking systems within pre-determined timelines.
• Other assigned activities as determined by the prior authorization manager.

Qualifications:

Knowledge, Skills, and Abilities:

• Excellent oral and written communication skills.
• Strong customer focus with commitment to providing excellent customer service.
• Ability to identify and interpret drug names, uses, and doses.
• Ability to focus on detailed information.
• Ability to adapt to a changing work environment including scheduling flexibility with the potential to work evening and weekend hours.

Education and Experience:

• Pharmacy Technician (certification recommended within first year of employment) or licensed health care professional.
• Certified pharmacy technician preferred.
• Two years of pharmacy technician or equivalent health care delivery experience including pharmacy call center experience.
• Experience with third party medical/prescription payment and/or claims adjudication systems: RxClaim system experience a plus.