Certified Pharmacist

7 days ago

Quezon City, National Capital Region, Philippines Intelassist Full time ₱360,000 - ₱720,000 per year

EOR: One Workforce Global
Employment Type: Full-Time Employment
Work Setup: 100% Onsite (Office location in either Eastwood, Clark or Muntinlupa)
Work Schedule: Night Shift (Following U.S. Central Time Zone)

Duties and Responsibilities:

  • Intake and triage PA requests from providers, pharmacy, and patients; confirm eligibility and benefits.
  • Gather required clinical information (diagnosis, labs, previous therapies, step-therapy/QL/ST documentation).
  • Prepare and submit PA requests via PBM/payer portals, eFax, or phone (e.g., CoverMyMeds, NaviNet, payer sites).
  • Track cases to decision; proactively follow up on pending requests and expiring authorizations.
  • Document all activities and outcomes in the EHR/pharmacy system and workflow tracker; maintain queue SLAs.
  • Communicate decisions to patients and prescribers; coordinate next steps with dispensing/specialty pharmacy.
  • For denials, collect missing info and prepare first-level appeals or redeterminations per policy.
  • Maintain current knowledge of plan formularies, UM criteria, Medicare Part D, Medicaid, and commercial payer rules.
  • Protect PHI and follow HIPAA, company policies, and quality standards

Job Requirements:

  • Active RPH License is preferred.
  • Prior Authorization experience for at least 4 years is required.
  • Experience working in the pharmacy setting is a must.
  • Versed in NextGen and Prior Authorization software (ex. CoverMyMeds) is a plus.
  • Detail-oriented with strong organizational skills
  • Ability to follow SOPs and meet deadlines
  • Excellent verbal and written communication skills
  • Excellent interpersonal and customer service skills
  • Excellent organizational skills and attention to detail
  • Excellent time management skills with a proven ability to meet deadlines
  • Strong analytical and problem-solving skills
  • Ability to prioritize tasks
  • Ability to function well in a high-paced and at times stressful environment

WHY INTELASSIST?
We grow together. We value your effort. We aim to empower you.

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