Under the supervision of a licensed pharmacist, receive and process prior authorization requests through the criteria based prior authorization process,
maintaining complete, timely, and accurate documentation of all approvals and denials, transferring all clinical questions or judgment calls to the pharmacist.
Provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members) and internal team members. Resolves
outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines including drug formulary
alternatives, prior authorization criteria and group/member eligibility problems. Researches and solves administrative review issues.
Performs duties to support goals and objectives of Geisinger Health Plan.
Must be able to work in a dynamic environment. Position must develop a strong healthcare/insurance industry knowledge base.
Reports to the Utilization Management Coordinator.
COMPETENCIES AND SKILLS:
Demonstrates ability to review complex clinical documentation with high degree of concentration for sustained periods of time.
Demonstrates effective communication skills, proficient organization skills, and self-motivation while able to prioritize and complete multiple functions in
a timely manner in a fast-paced environment.
Demonstrates attention to detail and concern for accuracy.
Demonstrates ability to prepare and present meaningful oral and written reports.
Demonstrates mathematical and problem-solving skills.
Demonstrates database and spreadsheet software proficiency.
EDUCATION AND/OR EXPERIENCE:
High school diploma or GED required. .
Minimum two years of Pharmacy Tech experience and current certification by the Pharmacy Technician Certification Board required. Previous Pharmacy Tech
experience in a hospital environment required.
Requires thorough knowledge of medical insurance coverage, reimbursement and regulatory requirements.
Proficiency in Microsoft office required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.