REMOTE Pharmacy Technician - NY State Resident

The Pharmacy Technician supports multiple pharmacy operations areas, including formulary management, pharmacy audit and recovery, pharmacy service center, Medicare Part D and Part B, appeals, state health programs pharmacy operations, prior authorization, and oversight and audit support. Using established guidelines, this role reviews requests from physicians, pharmacies, medical groups, and members for prescription drugs and pharmacy benefits, researches and resolves issues, and collaborates closely with clinical pharmacists and other healthcare professionals to ensure accurate, compliant, and timely processing of pharmacy-related requests.

• MUST RESIDE IN THE STATE OF NEW YORK***

The Pharmacy Technician supports multiple pharmacy operations areas, including formulary management, pharmacy audit and recovery, pharmacy service center, Medicare Part D and Part B, appeals, state health programs pharmacy operations, prior authorization, and oversight and audit support. Using established guidelines, this role reviews requests from physicians, pharmacies, medical groups, and members for prescription drugs and pharmacy benefits, researches and resolves issues, and collaborates closely with clinical pharmacists and other healthcare professionals to ensure accurate, compliant, and timely processing of pharmacy-related requests.

• Review and process formulary change requests from health plans and submit updates to the pharmacy claims processor.
• Generate, maintain, and review formulary status grids to ensure accuracy and contract compliance.
• Use reports to perform audits and quality checks on current formulary status.
• Assist clinical pharmacists with formulary database maintenance and updates to the company website.
• Perform a variety of assignments related to pharmacy audit and recovery functions.
• Review paid claims for quantity and billing discrepancies and communicate findings to pharmacies.
• Send fax inquiries to pharmacies regarding audit findings and respond to faxed correspondence.
• Answer incoming calls from pharmacies and respond appropriately to questions and concerns.
• Update databases, including Access, with information from phone calls, faxes, and emails.
• Take member inquiry calls regarding pharmacy benefits, including prior authorization requests.
• Maintain expert knowledge of Medicare pharmacy benefits and formularies, including relevant regulations.
• Educate members on their specific pharmacy benefits and explain options such as prior authorization requests.
• Process member‑submitted pharmacy claims accurately and efficiently.
• Review requests from physicians and pharmacies for non‑formulary drugs, drugs requiring prior authorization, and prescriptions that exceed quantity or cost limits.
• Assign, enter, and document prior authorizations into the appropriate claims processing system.
• Answer phone calls related to prior authorization inquiries and provide clear information.
• Research and resolve issues using appropriate reference materials and tools.
• Understand and interpret pharmacy and medical benefits to support accurate decision‑making.
• Review and process Medicare Part D event (PDE) files.
• Assist with pharmacy claims correction projects and perform audits and quality checks on active prior authorization claims.
• Help identify and correct eligibility and group issues and process member claims as needed.
• Serve as a liaison to internal and external departments for state health program pharmacy operations.

• High school diploma or GED.
• At least 1 year of experience as a Pharmacy Technician.
• Experience with pharmacy operations such as formulary management, prior authorization, or claims processing.
• Strong data entry skills and…