Pharmacy Technician - Temporary Part Time

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Wheeling, WV, US

The Pharmacy Technician is responsible for answering member, pharmacy, and provider questions as well as researching and resolving problems, to help members understand and optimize the use of their pharmacy benefit. Pharmacy Technicians also work with pharmacists to help review drug coverage requests from members, physicians, and pharmacies to determine medication coverage based on benefit plan design, client specifics, clinical notes, and clinical criteria according to the utilization management system(s).

Required:

• High School diplomaorequivalent.
• Oneyearexperienceina retail,hospital,managed care,orothersimilarpharmacysetting.
• Minimum typing speed of35 words per minute
• Demonstrateworkingknowledgeofdirectclaimsprocessing,pharmacycomputersystems, spreadsheet applications (i.e., Microsoft Excel), phone system and other office/computer equipment as required.
• Knowledgeofpharmaceuticalgeneric andtradenames.
• Abilitytocomprehendandfollowestablishedofficeroutines,policies,and procedures.
• Effectiveoraland writtencommunicationskills,includinggrammarandspelling.
• Strongorganizationalskills,timemanagementandmulti-tasking abilities.
• Detailorientedwithadvancedanalyticalandproblem-solving skills.
• Abilitytoworkeffectivelyaspartofateamandindependently.
• Follow all plan policies and procedures.
• Degreeinhealth-related field.
• Experience performing medication authorizations in pharmacy or managed care environment.

Responsibilities:

• Completes medication coverage requests through prior authorization criteria and escalates requests to
  
  Clinical
  
  Pharmacists or Medical Directorswhenrequestsrequireclinicalrevieworisnotapprovable through the automated system.
• Contactsproviderstoobtain allnecessaryinformationforcoverage requests prior to referring cases to Clinical Pharmacists or Medical Directors.
• Attaches relevant policy(ies) for the medication requests to the case documents prior to referring cases to Clinical Pharmacists or Medical Directors.
• Identifies and documents the relevant policy information prior to referring cases to a Clinical Pharmacist or Medical Director for review.
• Resolvesanddocumentscoveragerequestoutcomesinpharmacybenefitmanager'ssystemand communicates decision to physician's office and/or members through verbal and/or written notification in accordance with company policies.
• Researches, resolves, and documents physician or member inquiries and grievances and documentsoutcomesinthepharmacybenefitmanager'ssystem,medicalreviewsystemor customer service tool in an accurate and timely manner.
• Providesverbalverificationofmember'splaneligibilityandapplicablepharmacybenefits.
• Utilizespharmacybenefitmanagerandmedicalreviewsystemtoupdate,modifyandextract member information.
• Detailsmembersandprovidersonpharmacybenefitinquiriessuchasformulariesand pharmacy networks.
• Assistspharmaciesinprocessingprescriptionclaims;reviewandtroubleshootclaimsfor accuracy and adherence to contract guidelines.
• Consultswithclinicalpharmacistsforguidanceandassistifnecessary.
• Gathers clinical documentation necessary for the performance ofmedicationreconciliationandyearlymedication reviews and refers documentation to a Care Management Pharmacist for review.
• Identifies and documents peer-to-peer requests and refers cases to a Clinical Pharmacist or Medical Director for review.
• Interactswithstaff,customerserviceandsupervisorstoensurebestpractices.
• Followspolicyandprocedurespertainingtoalllinesofbusiness.
• Ensuresturnaroundtimes meetrequirementswithcompany,state,andfederalregulations.
• Meets internal key performance indicators as defined in The Health Plan's Policies and Procedures.
• Explains Appealand Grievanceprocesstomembersandproviders .
• Identifies, documents, and sends appeal requests to the Appeals and Grievances Department per Appeal and Grievance Department Policies and Procedures.
• Assists Appeals Coordinator ,Clinical Pharmacist and Compliancewithpharmacybenefit  grievances as needed.
• Handles calls and correspondence after hours (when scheduled) regarding pharmacy issues from providers and members.
• Pharmacy Technicians are responsible for reporting any changes in licensure status (e.g., application declined/denied; license revoked/suspended or lapsed; notification of an investigation by licensing board; becoming subject to disciplinary action by a licensing board) to their direct supervisor…