Pharmacy Technician

Job Description

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. **

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