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Pharmacy Technician Team Lead

Company: Healthcare Support
Location: Boise
Posted on: February 15, 2020

Job Description:

Position Overview: Manage the Pharmacy Services Helpdesk functions and personnel, including accountability for operational aspects and delegation of duties to the helpdesk. Coordinate application of pharmacy services and benefits. Handle pharmacy-related inquiries and communicate benefit determination. Act as a liaison and information resource to internal and external pharmacy services customers. Provide pharmacy claims processing services. Conduct claims audits and prepare prior authorization statistics. The primary point of contact for specific pharmacy programs. Essential Responsibilities: Interface with vendors and facilitate operational functions not otherwise managed by the Director of Pharmacy or the Clinical Pharmacist. Work closely with the Director of Pharmacy and Clinical Pharmacist on benefit configuration, formulary development, member and provider communications, network development, clinical quality programs and other projects as assigned. This will include delegation of key tasks to the Pharmacy Services helpdesk. Generate reports and data compiled for internal and external customers, including market share, vendor contracts, statistical reviews, large group reporting requests, drug rebate calculations, group experience, and utilization data. Compile and manage the utilization management statistics. Conduct monthly claims audit of pharmacy claims. Designated trainer for Pharmacy Services. Handle restricted member inquiries and needs. Act as backup contact regarding drug pre-authorizations and system overrides. Help to resolve issues related to pharmacy services. Ensure all coverage determinations are processed in a timely and accurate manner, consistent with Medicare & Medicaid oversight and department policies. Provide support and maintenance for department communication tools. (ie.Sharepoint) Participate in member outreach events and company sponsored health fairs. Act as the pharmacy contact person for the Empower program, as appropriate. Act as the pharmacy contact person for the Free and Clear program, as appropriate. Initiate phone consultations for high-risk members to improve medication adherence. Assist Pharmacy Director to ensure compliance with government programs (FWA, P&P development, CMS & DMAP policies, report generation & submission, etc). Assist the Enrollment & Billing team in managing the pharmacy enrollment process. Analyze pharmacy utilization data to formulate recommendations for maintaining and improving the delivery of pharmacy services to our members. Coordinate business activities by maintaining collaborative partnerships with key departments. Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports. Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities. Actively participate as a key team member in department meetings. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy. Directly supervise the Pharmacy Helpdesk staff, including providing day-to-day direction and internal quality oversight. Conduct regular department meetings and one-on-one meetings with the Pharmacy Services team. Supporting Responsibilities: Provide backup for pharmacy-related calls. Collect appropriate clinical and benefit information. Relate determination decisions. Function as liaison with pharmacy benefit management company, pharmacies, physicians, and others in order to apply benefits, and assist with pharmacy benefits determinations. Research new pharmaceuticals and indications to help determine clinical appropriateness, cost, coverage, and copayments. Consult with Director of Pharmacy Services and other professional staff in determining coverage for pharmacy-related services and pharmaceuticals. Prepare and process member-submitted pharmacy claims in the pharmacy benefit managers claims processing system. As a back up to the pharmacy helpdesk, engage members in a discussion of pharmacy benefits to ensure understanding and satisfaction with plan pharmacy design. Perform other duties as assigned. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Meet department and company performance and attendance expectations.

Keywords: Healthcare Support, Boise , Pharmacy Technician Team Lead, Healthcare , Boise, Idaho

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