Ideal candidate profile:
- Pharmacy Techs

- Pharmacy Techs with prior authorization experience

- RCM or Medical Assistants who can navigate an EMR system

Serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, Facilities, Physicians and PDP's regarding Therapeutic Interchanges, and prior authorization requests. They are responsible for investigating and calling the plans to determine the reasons for payment denials, the Physicians, and Facilities to provide the reasons for denial, while updating and documenting prior authorizations with clinical justifications, under the supervision of a registered Pharmacist.

Med D Biller's are pharm techs completing the Prior Authorization process. The Prior Authorizations they are completing have all been denied (about 70% of the claims are denied surprisingly), so this team goes over them with a fine tooth comb and make sure they have all information prior to sending it to Pharmacist to send out.