Clinical Prior Authorization Representative - Pharmacy Technician

At Shields, improving lives and elevating performance are at the heart of everything we do. That's why more health system leaders trust Shields to elevate access, outcomes and growth within specialty pharmacy — delivering value throughout the entire health system. Leveraging our proven Shields Performance Platform – we deliver the financial results that health systems demand and the superior outcomes patients deserve. With the foremost leaders in specialty pharmacy on our team; proven success partnering with more than 70 health systems; and a vested interest in delivering measurable results – we are the partner health systems trust to transform their specialty pharmacy into a powerful growth engine and elevate performance where it matters most.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Job Purpose:

Within this role, this person will provide patient care by removing the barriers to medication access. Working with insurance companies and clinician offices to facilitate approval of medications through prior authorizations. Working with patients and a variety of funding sources such as foundations, or directly through manufactures to obtain financial assistance for high dollar co-pays. Provide phone support to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims, refill medications, and increase adherence in patients.

Job Duties:

• Directly communicate with insurance companies to facilitate the approval of medications
• Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up
• Effectively communicate across databases, electronic medical records and emails to document patient concerns, prior authorization status, and financial assistance needs.
• Review prescriptions with doctors' offices to ensure optimal care of the patient
• Keep complete and accurate records of patient communications
• Assist patients in the management of their pharmacy insurance claims
• Work closely with pharmacists and pharmacy liaisons to provide an integrated approach quality patient care
• Communicate directly with patients over the phone to assist them in all aspects of medication compliance
• Research and investigate information to enable strategic decision-making by others
• Manage, organize, and update relevant data using database applications
• Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards
• Identify trends, resolve problems; recommend improvements; implement change
• Actively participate in process improvement initiatives
• Act as a value-added business partner to stakeholders throughout the organization
• Protect organization's value by keeping information confidential
• Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
• Minimal in or out of state travel may be required
• Perform other duties as assigned

Experience/ Education:

• We are seeking experienced pharmacy technicians with 1+ years of experience. Active and unencumbered pharmacy technician licensure or national pharmacy technician certification is required.
• If not nationally certified prior to hire, candidate will need to attain national certification, preferably within 6 months of hire or within agreed upon amount of time. May be required to attain additional state pharmacy technician licensure where applicable.
• Continued employment is contingent upon meeting these requirements.
• We are looking for someone with strong phone skills
• Highly proficient in Microsoft Office particularly Excel and Word.
• Ability to quickly learn other database programs (knowledge of the Willow, Qs1, and RX30 software system a plus) and able to identify relevant information with a focus on quality.
• The applicant should be very organized with attention to detail and have great interpersonal skills, high integrity, be dependable and a good listener and an empathetic communicator.
• The ideal candidate will be an energetic and highly motivated, team player with a willingness to do whatever is necessary for the betterment of the company.
• High school diploma or GED required.
• Discretion and confidentiality are essential as position deals with highly sensitive and private data.