The Prior Authorization Pharmacy Technician I will process coverage determinations (prior authorization and exception requests) to the Plan formulary. This position receives, researches, documents and processes the coverage determinations in a timely manner as required by regulatory requirements. This position also communicates decisions with providers, members and internal staff as directed by management.

Essential Functions:

· Receive, review, process and respond to coverage determinations to the Plan formulary in accordance with departmental guidelines and federal regulations.

· Provide support to internal and external customers and serve as a representative for the department both internally and externally.

· Maintain coverage determination policies and procedures, and assist with policy and procedure education for customers.

· Responsibilities may require evening and weekend work as well as overtime in response to Centers for Medicare and Medicaid Services (CMS) requirements.

Qualifications:

· High School Diploma or GED

· Current Pharmacy Technicians License in good standing with the Alabama State Board of Pharmacy

· CPhT (Certified Pharmacy Technician) from the Pharmacy Technician Certification Board or the National Healthcare Assoc

· Demonstrate excellent customer service skills through written and verbal communication