Pharmacy Services Technician

About the role

Join our Cause to create a person-focused and economically sustainable health care system. As a Pharmacy Services Technician, you'll be a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment.

Responsibilities

• Respond to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, government programs personnel, and customer service regarding formulary drug coverage, appeal and reconsideration claim status
• Complete daily formulary operational processes including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals
• Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation including medical chart notes, reports, and medication profiles; communicate information and determinations to providers and members orally and through written documentation as necessary
• Audit and investigate medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices; investigate and organize workflow for claims referred to Pharmacy Services for review and allowable determination including miscellaneous J codes, providers on review, and reconsiderations
• Support wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement; contribute to and support the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts

Requirements

• High school diploma or related certificate required
• Three years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting, or equivalent combination of education and experience
• Pharmacy Technician certificate may be substituted for two years of experience

Skills and Attributes

• Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS, and HIPAA regulations, along with knowledge of pharmaceutical products including orals, injectables, infusion products, and chemotherapy
• Demonstrated ability to perform pharmaceutical dosing calculations and operate a variety of standard business machines including calculators and faxes
• Ability to interact effectively with a variety of health care professionals including physicians, nurses, pharmacists, and billing staff both internally and externally, while demonstrating maturity, tact, diplomacy, and persuasiveness
• Ability to organize, plan, and prioritize daily workflow and projects within time constraints; experience with health insurance and/or prescription benefits preferred
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Benefits

The expected hiring range for a Pharmacy Services Technician is $20.50 - $30.80 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 5%. The current full hourly range for this role is $19.20 - $34.90 an hour.