Pharmacy Technician II

Job Summary :

The Pharmacy Technician III is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department. They will also assist leadership in monitoring and oversight of work queues, work distribution, resource building, and process management.

Essential Functions :

• Review prior authorization requests for the member's pharmacy and medical benefit submitted by providers
• Send fax communications to providers when necessary
• Contact provider offices to follow up on failed faxes
• Educate CareSource providers about resources outlining formulary alternatives
• Place prior authorizations for when approval is appropriate in the prior authorization system(s)
• Initiate process for routing prior authorizations requiring review by a pharmacist
• Answer calls from providers regarding prior authorization requests prescription coverage and formulary issues in a timely manner
• Perform outbound calls to obtain information from providers and / or pharmacies
• Document all telephonic interaction in appropriate system(s)
• Ensure all methods of inquiries (fax, e-mail, ePA) and submissions are answered with in the state mandated period
• Involvement in special projects reviewed by the management team when needed
• Answer calls and troubleshoot issues from retail and specialty pharmacies
• Assist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questions
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Maintain knowledge and understanding of all processes and procedures for all markets on faxes and phones
• Responsible for taking pharmacy call center inquiries and responding to / resolving pharmacy claim adjudication issues
• Verify network status for providers submitting medical benefit prior authorization requests
• Able to identify training needs
• Will utilize self-opportunities for all skill sets
• Ability to handle and resolve provider complaints in a timely manner
• Monitor current processes and suggest changes when needed
• Adhere to all departmental and company policies and procedures
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$40,400.00 - $64,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Hourly

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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