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The Pharmacy Technician is responsible for receiving, reviewing, and processing pharmacy prior authorizations. In addition, the Pharmacy Technician will assist the Pharmacy Technician Team Leader, Clinical Pharmacist and Pharmacy Director with applicable pharmacy programs.
- Nationally Certified Pharmacy Technician – CPhT
- Arizona Pharmacy Technician License in good standing
- High School Graduate or equivalent
- Personal computer knowledge using MS Word and Excel or health care data system experience
- Strong organizational, prioritization, communications & mathematics skills
- Time management, leadership and organizational skills
- Pharmacy claims processing computer system experience
- Thorough knowledge of the principals and protocols of the medication prior authorization process and managed care pharmacy experience and/or retail pharmacy experience of not less than two years
- Medical Terminology Courses
- Business/College Courses
- Ability to effectively communicate verbal/written and work as a team member with all associates in a professional and business manner
- Must be customer service oriented and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills
- Ability to understand the importance of and respect the confidentiality of all patient information
- Understand the principles of managed care pharmacy
Skills / Requirements
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Receive phone inquiries from providers (physicians and pharmacy personnel) via an Automatic Call Distribution (ACD) system
- Verify member eligibility
- Verify and/or identify other insurance for co-ordination of benefits
- Verify Prior Authorization requests for corrections, dosage, quantity, and day supply
- Responsible for interacting with other departments to assist with member problems or questions and act as facilitator to resolve them
- Responsible for assisting the member services representatives with medication-related issue resolution, follow-up, or referral to the appropriate department in a timely and efficient manner within 24 hours of receipt
- Identify areas where systems modifications could result in operational improvements and report those to the Pharmacy Technician Team Leader, Clinical Pharmacist or Pharmacy Director
- Assist the Pharmacy Technician Team Leader, Clinical Pharmacist and the Pharmacy Director in assuring efficient and effective operations of the Pharmacy Department and the Prior Authorization process
- Utilize the MHC system, Medco system (or current PBM processor), and the Pharmacy Prior Authorization Database to respond to inquiries regarding pharmacy Plan benefits and coverage explanations
- Assist Clinical Pharmacist with reviewing and maintaining drug information resources and formulary updates
- Assist Clinical Pharmacist and Pharmacy Director with communications to Pharmacy Benefit Manager (PBM)
- Responsible for assisting with the implementation of policies and procedures as requested by management
- Responsible for supporting department performance objectives
- Responsible for thorough follow-up and completion of all associate, member or provider inquiries
- Responsible for facilitating all department first-level complaints and/or issues and resolve them when possible, prior to forwarding them to the Pharmacy Technician Team Leader, Clinical Pharmacist or Pharmacy Director for resolution
- Responsible for informing the Pharmacy Technician Team Leader, Clinical Pharmacist or Pharmacy Director of all unresolved pharmacy issues or questions and act as facilitator to resolve them
- Responsible for always maintaining respect for member confidentiality and privacy, such as not expressing opinions about members that can be overheard by others
- Responsible for maintaining professional and appropriate behavior (actions/verbal) at all times and assure that all members of the department maintain appropriate behavior as well
- Responsible for utilizing courteous phone protocol and etiquette at all times and maintaining a professional image
- Responsible for providing a pleasant and professional customer service experience to all external and internal customers
- Responsible for immediately reporting all acts of inappropriateness and/or company policy violations to the Clinical Pharmacist or the Pharmacy Director
- Act as resource in the absence of the Pharmacy Technician Team
- Responsible for any other duties/responsibilities as assigned
- Assist Pharmacy Director with communications to oversight regulatory agencies
- Responsible for getting requests out in a timely manner according to AHCCCS guidelines
- Understands and abides by all departmental policies and procedures as well as the organization’s Corporate Integrity Program.
- Attends mandatory Corporate Integrity Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class.
- Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position.
- Abides by all applicable laws and regulations as mandated by state and federal laws and prevents being excluded or sanctioned from any state and/or federal programs as they pertain to healthcare.
- Represents the organization in a positive and professional manner in the community.
- Maintains organizational confidentiality at all times.
- Complies with all organizational policies regarding ethical and compliant business practices.
- Appearance is professional and exemplary at all times.