Job Description

Job Description

Client Overview:

Our client, a major PBM (Pharmacy Benefit Services) entity owned by 20 non-profit health plans serving >33 million members and benefits manager of government programs including Medicare and Medicaid, seeks an accomplished Certified Pharmacy Technician.

POSITION: Certified Pharmacy Technician - REMOTE

LOCATION: 100% REMOTE || Candidate should be in California

DURATION: 6 months contract with potential of extension/conversion to FTE

NO Time-Off policy by the client during the Training period i.e., 1st 4 weeks.

IMPORTANT Remote / Work-From-Home related:

• Equipment will be provided.
• Candidate MUST have a high-speed wired internet connection. Wi-Fi / Wireless connections are not allowed as a violation of policy and can lead to a breach of Private Health Information (PHI).
• Candidate MUST have a reliable home-office environment.
• Candidate MUST be on camera during training/work hours, especially during attendance calls.
• Candidate MUST follow business casual dress code during working hours.

What we need for the submission:

• An updated copy of your resume.
• Copy of diploma/ degree (highest earned).

Job Responsibilities:

• The Pharmacy Technician is responsible for evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or fax using client criteria. Primary duties may include, but are not limited to:
• Determines appropriateness for medications. Communicates decisions to physicians, physician`s office staff, medical management staff, and/or pharmacists.
• Researches, resolves, and documents prior authorization outcomes in the pharmacy system.
• Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician`s office staff, medical management staff, and/or pharmacists.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.
• Researches, resolves, and documents physician or client inquiries and grievances and provides verbal or written results to the client, prescriber, provider, and/or management.
• Verifies member information and inputs data for the pharmacists.
• Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs.
• Processes prior authorization requests from physicians’ offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations.
• Provides resolution to grievances and appeals issues.
• Maintains record keeping of prior authorizations, rebates, and monthly reports.

Requirements:

• Requires High School diploma or GED, and 2 years of pharmacy experience.
• Current National Certification and State Pharmacy Tech Certification based on applicable state(s) are required.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology, and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in Pharmacy computerized systems and software applications, as well as Windows-based applications and MS Office Product Suite.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.

Preferred Qualifications:

• Prior call center experience is strongly preferred.
• Medical terminology training, pharmaceutical terminology experience, and/or experience in the medical, insurance or pharmaceutical field are preferred.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• Ability to respond to escalated concerns in a calm and professional manner in an attempt to prevent further escalations.

NOTE:

• Candidates who are offered a position are required to pass pre-employment drug and background screening.

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