Clinical and Technical Call Center Pharmacy Technician

Pharmacy Technician

The Pharmacy Technician for the PBM clinical and technical call center is expected to be a subject matter expert in areas of pharmacy knowledge as well as call center operations. Duties will include, but are not limited to, answering incoming calls and making outgoing calls for members, medical providers, or pharmacy providers, appropriate processing of prior authorization requests, and assisting members and providers with inquiries through other media platforms as needed (fax, web, e-mail).

Responsibilities:

• Remain compliant with all PHI protocols and requirements including the handling of company confidential data according to policy and guidelines. Adheres to existing security policies and procedures.
• Process submitted prior authorization requests within the required time frame mandated by the State client
• Completion of approval process for prior authorizations where all criteria is met and clinical judgement of a pharmacist is not required
• Complete necessary communication with providers regarding status of their authorization submission or any other inquiries
• Follow standard operating procedures to receive incoming calls and use learned knowledge and resources to resolve the call on initial contact
• Provide a positive experience when communicating with members and providers
• Complete outreach to providers to obtain information when required
• Appropriately document all inquiries received via phone, fax, or email for members or providers
• Provide a high level of customer care with our members and providers
• Meet all department requirements, goals, and performance expectations
• Complete all tasks assigned within regulatory guidelines
• Actively identify areas of inefficiencies and provide innovative suggestions to leadership to keep processes current
• Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements.
• Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area. Demonstrates knowledge and skill in assigned work processes.
• Complete any additional job-related tasks as requested

Skills:

• Strong verbal and written communication skills
• Balances accuracy, quality, and efficiency in all tasks
• A willingness and ability to learn internal systems/processes/programs, as needed
• Basic math skills
• Familiarity with medication names and medical terminology
• General computer knowledge including Microsoft Office, use of the internet, and email is required
• Ability to learn quickly, solve problems, and make decisions with minimal supervision
• Ability to adapt and work collaboratively in a fast-paced, production environment
• Willingness to work a flexible schedule to accommodate peak volume times
• Excellent attention to detail
• Effective communication skills with internal and external clients, verbally and written
• Knowledge of pharmacy insurance claims
• Organization skills to balance and prioritize work
• Ability to multi-task
• Ability to work independently and as part of a team

Requirements:

• Must be at least 18 years of age
• High school diploma or GED required
• Active pharmacy technician registration with a Board of Pharmacy or certified pharmacy technician from accredited program (PTCB, ExCPT, etc.) or must obtain certification within 12 months
• 2 years of relevant experience as a pharmacy technician in retail pharmacy, hospital pharmacy, managed care, insurance, or pharmacy benefit management