Pharmacy Call Center Technician

Pharmacy Call Center Technician

Under the direct supervision of the Supervisor, Pharmacy Services Call Center, the Pharmacy Call Center Technician is responsible for providing knowledgeable and courteous customer assistance and response to members, providers and Pharmacy Call Center Technician inquiries. Principal accountabilities include handling calls and correspondence regarding pharmacy issues from providers/physicians and members, identifying and/or responding to inquiries, benefit payments, complaints, dissatisfactions, grievances and claim issues. The technician documents calls in an inquiry tracking system, ensures resolutions are presented in a clear and accurate manner, and facilitates problem resolution acting as the customer's advocate.

The technician reviews daily work activity reports to self-monitor performance and productivity standards, identifies deficiencies/problems, and adjusts behavior and work activities as appropriate. They perform initial research of pharmacy issues, reconcile plan information utilizing department-generated procedures and reference materials, and appropriately escalate claims outside knowledge and/or clinical scope to higher-level call center staff or pharmacist for review. They utilize internal pharmacy systems to update, modify and extract member information.

The technician assists network pharmacist in processing prescription claims, reviews claims for accuracy and adherence to contract guidelines, reviews and authorizes appropriate faxed medication requests from institutional/long term facilities, and maintains consistent contact with all facilities to assure KMHP protocols are maintained. They assist with entering prior authorizations when required, provide follow up assistance for prior authorization requests, follow up with request from physicians for denial letters, and provide assistance in gathering historical claim information as required. They provide Level II Pharmacy Technician, Supervisor and/or Pharmacist with background data needed for claim review, appeals and grievances.

The technician discriminates between routine and significant matters, apprises management of issues which can negatively affect service and business, identifies provider/physician/member issues and refers to appropriate departments, suspends inquiries forwarded to pharmacists or other departments and follows through to ensure timely resolution. They maintain a balance of productivity, quality and timeliness of job accountabilities, participate in department self-audits procedures for on-going evaluation of services, identify and define problems and opportunities within work area and attempt to resolve through appropriate channels, demonstrate flexibility and cooperation when faced with changing priorities to meet shifting needs.

The technician creates and supports an environment which fosters teamwork, cooperation, respect and diversity, establishes and maintains positive communication and professional demeanor with KMHP employees and clients at all times, adheres to KMHP policies and procedures, supports and carries out the Mercy Mission and Values, demonstrates and supports commitment to corporate goals and mission. They perform other related duties and projects as assigned, assist with training of new hires, attend required training as requested, develop and maintain desktop procedures.

Position qualifications/requirements include a high school diploma or the equivalent, 2 years of pharmacy technician experience in a healthcare, long term care or retail environment, and national pharmacy technician certification.