Pharmacy Benefit Technician
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Job Description
Pharmacy Benefit Technician handling calls regarding pharmacy issues and prior authorizations. Responsible for processing requests and serving as a liaison with pharmacy benefit managers.
Responsibilities:
- Responsible for following policies and procedures set within the pharmacy department to ensure that Members obtain appropriate medications in a timely, cost-effective, and efficient manner.
- Requires use of and proficiency in multiple computer programs.
- Handle calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale.
- Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member to clarify the intent of the prior authorization and identify any potential missing information.
- Enter prior authorizations and formulary exception requests into referral form.
- Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review.
- Complete initial and benefit denial letters.
- Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise.
- Serve as a resource for other departments within the health plan.
- Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.
Requirements:
- Pharmacy technicians must have a minimum of a high school diploma or equivalent.
- Experience with inpatient and retail pharmacy utilization, as well as a broad knowledge of pharmacy practice is preferred, but not required.
- Familiarity with computers and ability to work with multiple programs at the same time is required.
- Must have excellent oral and auditory skills for productive interoffice dialogue and Member or provider interactions.
- Must be nationally certified (CPhT designation), either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA).
- South Dakota: Registration required within 30 days from the date of hire.
- Technicians registered with South Dakota Board of Pharmacy after July 1, 2014 will be registered as a “technician-in-training” and will have two years to complete training education and national certification through the Pharmacy Technician Certification Board (PTCB).
- Failure to obtain National Certification within two years of registering as a “technician-in-training” will result in termination of position.
- Technicians registered with the South Dakota Board of Pharmacy after July 1, 2011 will be required to obtain National Certification through the Pharmacy Technician Certification Board by July 1, 2014.
- Failure to obtain National Certification will result in termination of position.
- Technicians registered with South Dakota Board of Pharmacy before July 1, 2011 will be grandfathered in and not require national certification through Pharmacy Technician Certification Board.
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