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.