Overview:
SXC Health Solutions Corp. is redefining pharmacy benefit management by providing a broad range of pharmacy spend management solutions and information technology capabilities. Our product offerings and solutions combine a wide range of PBM software applications, application service provider (ASP) processing services, and professional services designed for many of the largest organizations in the pharmaceutical supply chain, such as pharmacy benefit managers, managed care organizations, self-insured employer groups, retail pharmacy chains, and state and federal government entities.
Responsibilities:
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. The representative must have the ability to work cooperatively in a team environment ? associate will work with the team members to meet SXC?s PA clients? needs Essential Job Functions: ? 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 is 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 Ability Requirements: ? Excellent oral an 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 Requirements: ? 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
