Pharmacy and Drug Rebate Services, Technician

Summary

The Pharmacy Technician for the PBM clinical and technical call center is expected to be a subject matter expert in areas of pharmacy knowledge as well as call center operations. Duties will include, but are not limited to, answering incoming calls, and making outgoing calls for members, medical providers, or pharmacy providers, appropriate processing of prior authorization requests, tracking productivity, and assisting members and providers with inquiries through other media platforms as needed (fax, web, e-mail).

Your role in our mission

• Remain compliant with all PHI protocols and requirements including the handling of company confidential data according to policy and guidelines. Adheres to existing security policies and procedures.

• Process submitted prior authorization requests within the required time frame mandated by the State client

• Completion of approval process for prior authorizations where all criteria is met, and clinical judgement of a pharmacist is not required

• Complete necessary communication with providers regarding status of their authorization submission or any other inquiries

• Assist member and providers in understanding pharmacy claims status, reject reasoning, drug coverage rules, plan benefits, and assist with instructions on steps they may need to take as applicable.

• Follow standard operating procedures to receive incoming calls and use learned knowledge and resources to resolve the call on initial contact

• Provide a positive experience and clear communication with members and providers

• Complete outreach to providers to obtain information when required

• Appropriately document all inquiries received via phone, fax, or email for members or providers

• Provide a high level of customer care with our members and providers

• Meet all department requirements, goals, productivity targets, and performance expectations

• Complete all tasks assigned within regulatory guidelines

• Actively identify areas of inefficiencies and provide innovative suggestions to leadership to keep processes current

• Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements.

• Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area. Demonstrates knowledge and skill in assigned work processes.

• Complete any additional job-related tasks as requested

What we're looking for

• Must be at least 18 years of age

• High school diploma or GED required

• Active pharmacy technician registration with a Board of Pharmacy or certified pharmacy technician from accredited program (PTCB, ExCPT, etc.) or must obtain certification within 12 months

• 2 years of relevant experience as a pharmacy technician in retail pharmacy, hospital pharmacy, managed care, insurance, or pharmacy benefit management

• Knowledge of Microsoft office applications, e-mail, and computer applications required

What you should expect in this role

• Effective communication skills with internal and external clients, verbally and written

• Balance’s accuracy, quality, and efficiency in all tasks

• A willingness and ability to learn internal systems/processes/programs, as needed

• Basic math skills

• Familiarity with medication names and medical terminology

• General computer knowledge including Microsoft Office, use of the internet, and email is required