Industry: Private
Employment Type:- Full Time
Work Hours:- 8 Hours
Locations:- USA
Full Job Description:-
Job Summary
The Pharmacy Technician for American Health Plans is responsible for activities related to member access in the area of claims adjudication appropriateness and operations performed by the Plan’s Pharmacy Benefit Manager for a Medicare Advantage Institutional Special Needs Plan (I-SNP).
Essential Job Duties
To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.
- Review daily point-of-service (POS) pharmacy claims, resolve actionable items, track, and provide reporting
- Serve as a liaison with Enrollment Department to assure appropriate member eligibility processing
- Effectively work with the PBM management team to effectively ascertain the highest level of Pharmacy Benefit Manager performance
- Recognize formulary requirements: prior authorization (PA, Step Therapy (ST), Quantity Limit (QL) and understand NCPDP reject codes
- Communicate with pharmacies, nursing homes, and providers
- Coordinate clinical reporting
- Follow-up and solve open items in a timely manner
- May be assigned to work on special projects and business initiatives
- Other duties as assigned
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Job Requirements
- Proficient with Microsoft Suite applications
- Ability to navigate multiple systems
- Strong analytical skills
- Proficient communication and presentation skills
- Adhere to Centers of Medicare and Medicaid Services (CMS) regulations and compliance requirements
- Successful completion of required training
Required Qualifications
- Education:
- High school diploma or equivalent
- Experience:
- Minimum of 2 years as a Pharmacy technician, long term care, or health plan experience
- Experience in planning and implementation
- License/Certification(s):
- Pharmacy Technician certification preferred
EQUAL OPPORTUNITY EMPLOYER
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.
