Pharmacy Technician

Description:

THIS IS A CALL CENTER & CANDIDATE NEEDS TO BE AWARE THAT THEY WILL BE TAKING INBOUND CALLS IN A HIGH VOLUME CALL CENTER

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

ESSENTIAL FUNCTIONS:

\- Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists.

\- Researches, resolves and documents prior authorization outcomes in 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 client, prescriber, provider and/or management.

\- Performs other duties as required.

-Ability to identify and trouble-shoot problematic issues.

Requirements/Certifications:

-PTCB: Certification REQUIRED

-Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.

-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 MS Office Product Suite.

-Excellent written and verbal communication skills.

-Ability to follow clinical criteria and instructions to approve prior authorization requests.

-Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.

-Ability to identify and trouble-shoot problematic issues.

*CANDIDATE WILL NEED TO BE AVAILABLE TO WORK ANY SHIFT MONDAY - SUNDAY; 9:00 AM-8:30 PM. WILL HAVE 2 DAYS OFF.

All your information will be kept confidential according to EEO guidelines.