Pharmacy Technician

Pharmacy Technician

The Program Specialist II (PSII) works independently on routine and moderately complex cases and exercises judgment within established program guidelines. As the primary case-management and benefits verification specialist for assigned programs, the PSII manages patient enrollment activities, benefit investigations, insurance verification, and routine patient access issues while serving as a primary point of contact for patients, providers, and payers. Complex reimbursement, prior authorization, appeals, and escalation issues are referred to the Program Specialist III or next level leader.

The PSII delivers an exceptional patient and provider experience through inbound and outbound telephony support, document triage, follow-up on missing information, data entry, and patient benefit verification activities. The PSII ensures adherence to program business rules, company policies and procedures, and HIPAA guidelines.

Essential duties and responsibilities include processing all incoming documents, handling inbound and outbound calls, completing benefit investigations and eligibility assessments, coordinating with patients, providers, and payers to obtain missing information, independently managing patient cases, maintaining confidentiality, demonstrating commitment to diversity, equity, and inclusion, and all other duties as assigned.

Expectations of the job include no travel, 40 hours per week, serving as the primary point of contact for healthcare providers and inbound callers, fostering a collaborative, team-oriented approach, communicating effectively, completing data entry tasks, recognizing, assessing, and appropriately escalating complex reimbursement or access-related issues, achieving productivity, quality, attendance, and service-level performance metrics, and special project support as necessary.

Minimum knowledge, skills, and abilities include a high school diploma/GED, one to two years of relevant experience in healthcare operations, benefit verification, or a related customer service role, advanced computer proficiency, reliability, independent judgment, customer focus, critical thinking, issue resolution, prioritization, clear communication, strong oral, written, and interpersonal communication skills, ability to obtain a Missouri pharmacy technician registration, and other technical and behavioral competencies.