Pharmacy Technician

Description:
*THIS IS A CALL CENTER POSITION WHERE THE CANDIDATE MUST BE AWARE THAT THEY WILL BE HANDLING INBOUND CALLS IN A HIGH VOLUME CALL CENTER.*

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

ESSENTIAL FUNCTIONS:

1. Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff, and/or pharmacists.
2. Researches, resolves, and documents prior authorization outcomes in pharmacy system.
3. Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician's office staff, medical management staff, and/or pharmacists.
4. Escalates requests to Pharmacist when extensive clinical review or denial is required.
5. Researches, resolves, and documents physician or client inquiries and grievances, providing verbal or written results to clients, prescribers, providers, and management.
6. Performs other duties as required.
7. Ability to identify and troubleshoot problematic issues.

Requirements/Certifications:

• PTCB Certification REQUIRED.
• Experience in specialty or retail pharmacy industry, reimbursement, or working in a health plan/healthcare setting.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management, medical terminology, and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in pharmacy computerized systems, software applications, and MS Office 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.
• Availability to work any shift from Monday to Sunday, 9:00 AM - 8:30 PM, with 2 days off.

Additional Information

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