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Pharmacy Services Intermediate 26329-1 MPK
Monterey Park, California | Contract
EXCITING 1 YEAR CONTRACT FOR PHARMACY SERVICES OPERATIONS TECHNICIAN!
Provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members and brokers) and internal team members. Resolves outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines including drug formulary alternatives, prior authorization criteria and group/member eligibility problems. Researches and solves administrative review and consumer affairs issues.
- Develops an interface with the physician, physician’ s office staff, medical management and other company team members to ensure accurate and efficient resolution of prior authorization requests
- Performs initial review of drug prior authorization requests and approve based upon P&T approved medication policies or pend for clinical review
- Complies with established processes to ensures prior authorizations requests are completed within regulatory turnaround times
- Researches and resolves physician inquiries related to prior authorization requests
- Supports company Member Services with resolution of pharmacy benefit issues that cannot be handled by front line CSRs
- Supports implementation of procedures and procedures for the outpatient prescription drug prior authorization program
- Provides formulary alternatives, member drug profiles, communicates prior authorization criteria, and other pertinent pharmacy benefit related information to authorized individuals upon request
- Performs other duties and assists with projects as assigned by supervisor
Problem Solving / Decision Making:
- Refers to policies and practices for guidance on non-standard problems
- Seeks guidance on non-routine assignments from peers or higher-level team members
- HS Diploma and 1 year of Pharmacy related experience and training
- Proficient in knowledge of Microsoft office (Word, PowerPoint, Visio & Excel)
- State Board as Certified Pharmacy Tech required
Minimum Experience Level:
- Demonstrated ability encompasses basic understanding of internal procedures and policies needed to ensure effective execution of assigned tasks
- May develop new concepts and techniques to improve effectiveness in execution of tasks