Healthfirst

Certified Pharmacy Technician - Bilingual Spanish/english

3+ months agoNew York, NY

The Certified Pharmacy Technician (CPT) position is a dynamic position responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The CPT is responsible for approval decisions/denial recommendations based on predetermined clinical criteria, updates to units requested, decision notification for members and providers, establishing good rapport with Provider offices, strong communication and customer service skills. The CPT position is part of multidisciplinary team and will work closely with Providers, Pharmacists, and Medical Directors.

Duties & Responsibilities:

  • Review prior authorization requests and units for medications requested under the medical benefit
  • Assess provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
  • Telephonic/ fax/ mail notification to members and providers of authorization decisions
  • Ensure prior authorization reviews are conducted in time-frames set forth by CMS and/or NYSDOH
  • Establish great rapport with Provider offices via telephonic communication
  • Send Providers request for information sheets
  • Ensure that patient information is always shared appropriately maintaining confidentiality and compliance with federal/HIPAA regulations
  • Additional duties as assigned


Minimum Qualifications:  
  • Pharmacy Technician in the state of New York with a certificate in good standing
  • Bilingual in Spanish and English
  • Minimum of 1 year experience conducting prior authorization reviews
  • Strong clinical background
  • Demonstrated critical thinking and problem-solving skills
  • Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities
  • Strong telephonic communication skills


Preferred Qualifications: 
  • Knowledge of specialty pharmaceuticals and billing practices in the medical benefit
  • Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
  • PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).
  • Experience with TruCare Care Management Platform


Regulatory or Compliance activities: 

Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.

Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Job ID: healthfirst-R009540