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Philadelphia , PA 19113
Posted 2 months ago
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Pharmacy Technician - Health PlanJob Type:
Full Time, CONTRACT-TO-HIRE
Philadelphia, PA (South Suburb, near Chester)About the Job:
CareNational, a leading medical management recruitment and staffing organization, is currently looking for aPharmacy Technician
for an expanding health plan inPhiladelphia, PA
You will be responsible for reviewing and approving physician inquiries for prior-authorization / pre-certification and medical necessity requests based on established pharmacy guidelines and contract criteria.Pharmacy Technician
Pharmacy Technician Background Profile:
- Reviews and approves physician inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.
- The Pharmacy Technicianis primarily responsible for assisting in administering and maintaining Medicare pharmacy programs in compliance with Medicare Part D guidelines.
- Using established guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits.
- They examine health insurance claims to assess whether the provider or the claim holder must pay for medical services that the claim holder received.
- They respond to issues and questions regarding the prior authorization of claims and the formulary process. Preforms review of processing claims to assess validity and determine financial responsibility for medical services that the member received.
- They assist with the education of internal staff and contracted providers on pharmacy related Medicare Part D topics.
- Duties include communicating with members and providers by phone and responding accordingly to concerns, adjusting and or referring complaints to appropriate departments, and investigating issues to find proper solutions.
- Maintains and updates internal databases, including application information, prior authorizations and other relevant data all while ensuring database information and appended files are current and accessible to staff.
Pharmacy Technician Benefits:
- Requires an education level of at least aHigh School Graduate or GED equivalent; Associates or Bachelorsdegree preferred.
- Highly prefer certification as a Certified Pharmacy Technician (CPhT) or Pharmacy Technician Certification Board (PTCB), or other industry-standard certification, is preferred.Around 1-3 years of Pharmacy Technician experience required, preferably in a managed care environment.
- Strongly prefer at least 1 year experience working at a Managed Care Organization, Pharmacy Benefit Management (PBM) company, or hospital, LTC, retail, home infusionpharmacy.
- Familiarity with Formulary Lists including common edits and restrictions.
- Must possess a solid understanding of pharmacy claims from the health insurance perspective.
- Demonstrated superior verbal communication skills by telephone.
- Excellent, clear speaking voice and solid command of the language.
- Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
- Functions well in an environment that requires incumbent to be a self-starter.
- Minimum 35 words per minute typing speed is required.
Position provides a comprehensive benefits plans that include Medical, Dental, and Vision. Including 401(k), PTO, Paid Holidays, and Life Insurance benefits.We are an equal opportunity employer and value diversity in our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.#ADMIN