Healthfirst

Certified Pharmacy Technician, UM

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 Minimum of 1 year experience conducting prior authorization reviews Strong clinical background Strong written and verbal communication skills in English 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: Strong written and verbal communication skills in Chinese, Spanish, or Russian 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.
Since we care so greatly about our employees' and members' wellbeing, Healthfirst has implemented various COVID-related health and safety requirements for our workforce. Employees are expected to follow the Company's current COVID-19 or other infectious disease health and safety protocols, including local requirements, which may include sharing information regarding your vaccine status and mask wearing. Protocols may change in the future with the evolving public health landscape. Healthfirst will consider accommodation requests as required by applicable law.

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.

Hiring Range:

  • Greater New York City Area (NY, NJ, CT residents): $46,200 - $62,400
  • All Other Locations (within approved locations): $40,100 - $58,240
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

Client-provided location(s): New York, NY, USA
Job ID: healthfirst-R009539

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