Pharmacy Technician
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Job Description
Pharmacy Technician supporting formulary management and claims resolution for Zing Health’s Medicare Advantage insurance members. Maintaining pharmacy programs, audits, workflows, and regulatory operations.
Responsibilities:
- Support the development, maintenance, and ongoing oversight of clinical and operational pharmacy programs and processes
- Manage administrative components of formulary creation, development, and maintenance
- Create, maintain, submit, and post formularies using a formulary management tool for all lines of business
- Partner with stakeholders to oversee formulary marketing materials, claims adjudication testing, and weekly PBM calls
- Support analysis of monthly and yearly formulary submissions
- Compare competitor drug coverage for all lines of business
- Assist customer services, network pharmacies, and health plan providers with prescription claims, prior authorization, appeals, and pharmacy access issues
- Participate in and support internal and government audits
- Participate in internal work groups as required
- Develop and maintain pharmacy operations workflows, job aids, and training materials
- Support resolution of member grievances
- Act as a pharmacy operations liaison with internal departments
- Develop materials and educate internal departments on pharmacy operations
- Support programs designed to enhance targeted therapeutic drug utilization and Part D STARS outcomes
- Complete special projects, including compiling information, generating reports, and maintaining records and files
- Follow Pharmacy Leadership direction regarding day-to-day operations and program management
- Track and formally respond to pharmacy-related inquiries from internal and external stakeholders
- Research and resolve medication issues using appropriate reference materials through complete issue resolution
Requirements:
- 2 years experience as a Pharmacy Technician
- High School Diploma or GED equivalent
- Active Certified Pharmacy Technician (CPh.T) license
- Experience in retail, hospital, or managed care pharmacy industry required
- Minimum of 2 years of experience in health care or health insurance industry preferred
- Experience working with Medicare Parts B and D and/or Medicaid Plans preferred
- Working knowledge of pharmaceutical managed care and PBM industries
- Ability to use pharmacy claim reports to perform audits and quality checks on active prior authorizations
- Working knowledge of pharmaceutical claims, language, drug usage, and generic substitution practices
- Computer skills and working knowledge of Microsoft products, claims processing software, and report generation
- Ability to learn new software applications
- Familiarity with formulary lists, including common edits and restrictions
- Strong knowledge of healthcare delivery
- Excellent listening, speaking, and writing skills
- Ability to plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments
- Ability to work well with one or more groups
- Ability to relate to co-workers and build relationships within the organization
Benefits:
- A competitive salary based on the market
- Medical, Dental, and Vision
- Employer-Paid Life Insurance
- Paid Maternal Leave
- Paid Paternal Leave
- 401(K) match up to 4%
- Paid-Time-Off
- Employee Assistance Programs
- Supplemental benefits, including Spouse Insurance, Pet Insurance, Critical Illness coverage, and ID Protection
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