PS Pharmacy Services Technician
Pharmacy Services Technician
Our client, a health care company on the leading edge of technology and changing how they interact with patients, is looking for a Pharmacy Services Technician for their Portland location. This position will be supporting corporate-wide as a technical support resource for pharmacy benefit, reimbursement, and other drug issues. We are looking for someone who has prior knowledge and experience with pharmaceuticals! If you think you’d be a good fit, we want to hear from you!
Pay: $18.00 – 20.00
Location: Remote – Local candidates ONLY
Responsibilities of Pharmacy Services Technician:
- 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.
- 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.
- 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.
- Conducts business in compliance with company’s Code of Business Conduct, immediately reports violations of the code to management, human resources, internal audit, legal of the compliance officer; and helps in investigating alleged wrongdoing.
Requirements of Pharmacy Services Technician:
- High School Diploma or GED Required. College graduate is highly preferred.
- 5+ years of experience as a pharmacy technician in a retail, hospital, or other licensed pharmacy setting; or equivalent combination of education and experience in a related field is required.
- Pharmacy Technician Certification may be substituted for 2 years of experience!
- Working knowledge with medical terminology.
- Working Knowledge of pharmaceutical products, including orals, injectables, infusion productions and chemotherapy.
- Working knowledge with healthcare coding systems such as ICD-9, CPT, and HCPCS.
- Working knowledge of HIPAA regulations.
- Must be able to interact effectively with a variety of healthcare professionals (physicians, nurses, pharmacists, billing staff, etc.)
- Must be able to perform pharmaceutical pricing calculations.
- Proven typing capability. 30+ words per minute, preferred 60+
- Experience with health insurance and/or prescription benefits is highly preferred.
** We are unable to accommodate corp to corp candidates **
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.
KG / Bullhorn #9092