Job Description
Remote Call Center Pharmacy Technician II
locations
Home
time type
Full time
job requisition id
R-10371
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Description Summary
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Job Description
- 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.
- Monitors telephone system to ensure adequate staffing to maintain client services levels.
- Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices.
- Demonstrates, advocates and reinforces a positive team environment.
- Other duties as assigned.
Responsibilities
- Must have an active pharmacy technician licensure or registration in accordance with state requirements.
- If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
- In states that do not require licensure or registration, or that restrict licensure to employees of dispensing pharmacies, must have an active national certification (e.g., PTCB or ExCPT).
- 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 2 years dispensing or retail experience required, or equivalent internal training will be substituted.
- Ability to identify and trouble-shoot problematic issues.
Work Experience
Work Experience – Required:
Pharmacy
Work Experience – Preferred:
Education
Education – Required:
GED, High School
Education – Preferred:
Certifications
Certifications – Required:
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements – Pharmacy – Pharmacy
Certifications – Preferred: