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Remote Prior Authorization Representative (PBM Support)
A-Line Staffing is now hiring Remote Prior Authorization Representative (PBM Support) Job Title: Remote Prior Authorization Representative (PBM Support) Location: Remote – United States Pay Rate: $18.00 - $20.00hr - biweekly pay Position Type: 3 - 12 month Contract (Temp-to-Perm Opportunity, with the potential to extend or transition to permanent employment based on business needs) Assignment Start Date: 2 weeks from offer Schedule: Monday through Friday, with assigned 8-hour shifts varying between 8:00 AM and 8:00 PM Central Time (CT). Training Schedule: Monday through Friday, 8:00 AM–4:30 PM CT, for six weeks. Training attendance is critical, and candidates must be available for the full training period without interruptions or scheduling conflicts. Overtime: Mandatory overtime may be required. Position Summary: The Pharmacy Technician Prior Authorization Representative provides professional telephone support to members, healthcare providers, and other callers throughout the criteria-based prior authorization process. This role focuses on managing high-volume inbound calls, accurately documenting authorization approvals and denials, coordinating administrative activities, and escalating clinical questions or judgment calls to the pharmacist. Candidates with high-volume healthcare call center experience are encouraged to apply. Pharmacy technician experience is strongly preferred but is not required for candidates who have the appropriate call center background and skills. Key Responsibilities: Inbound Call Management: Handle a high volume of incoming calls from members, providers, and other callers regarding prior authorization requests. Customer Service: Provide professional, accurate, courteous, and timely telephone assistance throughout the prior authorization process. Authorization Documentation: Maintain complete, accurate, and timely documentation of prior authorization approvals and denials. Clinical Escalation: Transfer clinical questions and decisions requiring professional judgment to the pharmacist. Administrative Coordination: Coordinate pharmacy technician activities within an administrative support function. Computer System Navigation: Navigate multiple computer systems while managing inbound calls. Data Entry: Enter information accurately and maintain detailed records of call activity and authorization requests. Microsoft Applications: Use Microsoft Office applications to support communication, documentation, and administrative tasks. Communication Tools: Use Microsoft Teams and Outlook as required. Confidentiality: Protect confidential healthcare information and follow applicable privacy requirements. Team Collaboration: Participate in required meetings, training sessions, and other assigned activities. Workflow Adaptability: Adjust to changing priorities and work effectively in a dynamic healthcare environment. Quality Assurance: Follow established procedures to support accurate processing, appropriate documentation, and consistent customer service. Required Qualifications: Call Center Experience: Minimum of one year of inbound call center experience. High-Volume Experience: Previous experience handling high-volume inbound calls is required. Customer Service: Strong customer service skills and the ability to communicate professionally with members and healthcare providers. Computer Skills: Advanced computer skills, including word processing and spreadsheet utilization. System Navigation: Ability to navigate multiple computer systems while simultaneously managing telephone calls. Data Entry: Strong data entry and documentation skills. Microsoft Outlook: Proficiency with Microsoft Outlook is required. Microsoft Teams: Proficiency with Microsoft Teams is required. Communication: Excellent written and verbal communication skills. Confidentiality: Ability to handle sensitive healthcare information appropriately and maintain confidentiality. Remote Work: Ability to work independently in a remote environment. Computer Use: Ability to work at a computer for the duration of the assigned shift. Organization: Ability to maintain accurate records and manage multiple administrative tasks. Schedule Availability: Availability to work assigned 8-hour shifts between 8:00 AM and 8:00 PM CT, Monday through Friday. Training Attendance: Ability to attend and complete six weeks of required training, Monday through Friday, from 8:00 AM to 4:30 PM CT. Overtime Availability: Willingness to work mandatory overtime when required. Preferred Qualifications: Healthcare Experience: Experience in healthcare, insurance, pharmacy benefit management (PBM), a pharmacy, a medical office, or a related field. Pharmacy Technician Experience: At least one year of experience as a pharmacy technician coordinating activities in an administrative support function is preferred. Pharmacy Knowledge: Familiarity with pharmacy operations and prior authorization procedures is strongly preferred. Certification: Pharmacy technician certification at the state or national level is preferred but not required. Licensure or Registration: An active pharmacy technician license, certification, or pharmacy technician trainee license is preferred. Microsoft Word: Familiarity with Microsoft Word is helpful. Microsoft Excel: Familiarity with Microsoft Excel is helpful. Healthcare Call Center Background: Candidates with strong high-volume healthcare call center experience may be considered even without previous pharmacy technician experience. Important Information for Candidates: Work Arrangement: This is a remote position requiring independent work and consistent performance. Schedule: Assigned 8-hour shifts fall between 8:00 AM and 8:00 PM CT, Monday through Friday. Training: Six weeks of training, Monday through Friday, from 8:00 AM to 4:30 PM CT. Attendance is critical, and candidates should have no scheduling conflicts during training. Overtime: Mandatory overtime may be required. Clinical Responsibilities: This is primarily an administrative and telephone-support role. Clinical questions and decisions requiring professional judgment must be escalated to the pharmacist. Call Volume: Candidates should be comfortable handling a high volume of inbound calls while maintaining accurate documentation and professional customer service. Technology Requirements: Candidates must be proficient in Microsoft Teams, Outlook, data entry, and navigating multiple computer systems. Pharmacy Technician Experience: Pharmacy technician experience and certification are preferred but not mandatory. Safety-Sensitive Designation: This position is classified as safety-sensitive. Employment Opportunity: The role offers the potential for an extension or permanent employment based on business needs. Conversion to permanent employment is not guaranteed. Benefits: Benefits are available to full-time employees after 90 days of employment. A 401(k) with company match is available after 1 year of service. #INDKS