Pharmacy Services Technician
Company: Cambia Health Solutions, Inc
Location: Boise
Posted on: April 23, 2024
Job Description:
Pharmacy Services TechnicianLooking for candidates within Idaho,
but the right candidate will be eligible for a remote role within
our 4-state footprint (WA, ID, OR, and UT). Primary Job PurposeThe
Pharmacy Services Technician is a corporate-wide technical support
resource for pharmacy benefit, reimbursement, and other drug use
issues which do not require clinical judgment. This function
assists the Clinical Pharmacy Consultants and Pharmacy Services
staff with formulary-related operations and other operational
processes which require knowledge and experience with
pharmaceuticals.Normally to be proficient in the competencies
listed below:Pharmacy Services Technician would have a high school
diploma or related certificate and five years of experience as a
pharmacy services technician in a retail, hospital, or other
licensed pharmacy setting or equivalent combination of education
and experience. Pharm tech certificate may be substituted for two
years of experience.Responsibilities:
- Performs all duties as described in this document unless doing
so would require clinical judgement. In any situation in which
clinical judgment is necessary, the Pharmacy Services Technician
will seek assistance from appropriate medical personnel.
Appropriate medical personnel will be available for support during
normal business hours.
- Responds to non-clinical pharmacy issues from providers,
pharmacy services staff, case managers, preauthorization nurses,
ENCC personnel, and government programs personnel and customer
service. These pharmacy issues include formulary drug coverage,
appeal and reconsideration claim status, and pricing for drug
claims.
- Completes daily formulary operational processes, including
tracking, processing, and obtaining appropriate documentation for
pharmacy medical exception requests, prior authorization requests,
reconsiderations, and appeals.
- Prepares reconsideration requests for Clinical Pharmacy
Consultant review by obtaining and organizing appropriate
documentation, including, but not limited to medical chart
notes/reports and medication profiles.
- Communicates (orally and by written documentation) information
and determinations to providers and members as necessary.
- Obtains and organizes drug utilization data, including patient
specific and population-based data, in a manner which facilitates
clinical review and decisions by Clinical Pharmacist Consultants.
Organizing data includes but is not limited to sorting drugs into
appropriate therapeutic and generic categories.
- Assists with auditing and investigations of medication-related
claims, cases, and providers to identify misuse of medications,
misuse of (Regence HMO Oregon) resources, substance abuse, and
erroneous and fraudulent billing practices.
- Investigates and organizes workflow for claims referred to
Pharmacy Services for review and allowable determination (misc. J
codes, providers on review, reconsiderations).
- Supports wellness and disease state management programs for
Pharmacy Service and corporately which contribute to NCQA
accreditation and ongoing quality improvement.
- Contributes to and supports the corporation's quality
initiatives through process improvement teams and by encouraging
team and individual contributions toward the corporation's quality
improvement efforts.Minimum Requirements:
- Knowledge of medical terminology, health care coding systems
such as ICD-10, CPT and HCPCS and HIPAA regulations.
- Knowledge of pharmaceutical products, including orals,
injectables, infusion products, and chemotherapy.
- Knowledge of general office practices and procedures.
- Demonstrated knowledge of grammar and techniques of business
practice.
- Ability to interact effectively with a variety of health care
professionals, including physicians, nurses, pharmacists, and
billing staff both internally and externally.
- Demonstrate maturity, tact, diplomacy, and persuasiveness.
- Demonstrated ability to perform pharmaceutical pricing
calculations.
- Ability to type 30 words per minute, 60 wpm preferred.
- Demonstrated ability to operate a variety of standard business
machines including calculators, copiers, and faxes.
- Basic computer programs skills (Word, Excel, etc.).
- Ability to organize, plan, and prioritize daily workflow and
projects within time constraints.
- Experience with health insurance and/or prescription benefits
preferred.Work Environment:
- Work primarily performed in an in-home environment.
- May be required to work overtime.
Keywords: Cambia Health Solutions, Inc, Boise , Pharmacy Services Technician, Professions , Boise, Idaho
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