Duties & Responsibilities:
Reviews prior authorization requests and units for medications requested under the medical benefit
Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
Sends notification to members and providers of authorization decisions via telephone, fax, or mail
Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
Establishes great rapport with Provider offices via telephonic communication
Sends request for information sheets to Providers
Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
Additional duties as necessary
Minimum Qualifications:
High School Diploma or GED from an accredited institution
Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
Experience conducting prior authorization reviews
Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional
Preferred Qualifications:
Strong written and verbal communication skills in Chinese, Spanish, or Russian
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
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
Compliance & Regulatory Responsibilities: Noted above
License/Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLCshallnotdiscriminateagainstanydisabledemployeeorapplicantinregard to any position for which the employee or applicant is otherwise qualified.
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 HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
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): $47,403 - $64,338
All Other Locations (within approved locations): $41,101 - $60,320
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.
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