Job Title:

Pharmacy TechnicianJob Description The Pharmacy Technician supports multiple pharmacy operations, including formulary management, pharmacy audit and recovery, pharmacy service center functions, prior authorization, Medicare Part D and Part B operations, state health programs pharmacy operations, oversight and audit support, and appeals. Using established guidelines, this role reviews and processes requests related to prescription drugs and pharmacy benefits, researches and resolves issues, and collaborates with clinical pharmacists and other healthcare professionals to ensure accurate, compliant, and timely handling of pharmacy benefits and claims. Responsibilities + Review and process formulary change requests from health plans in accordance with established guidelines. + Submit and maintain formulary change requests with the pharmacy claims processor and ensure accurate updates. + Generate, maintain, and review formulary status grids to support accurate benefit administration. + Use reports to perform audits and quality checks on current formulary status to ensure accuracy and contract compliance. + Assist clinical pharmacists with formulary database maintenance and updates to the company website. + Perform a variety of assignments to support pharmacy audit and recovery functions. + Review paid claims for quantity or billing discrepancies and correspond with pharmacies to communicate findings. + Fax inquiries to pharmacies related to review findings and document responses. + Answer incoming calls and respond to faxed correspondence from pharmacies in a timely and professional manner. + Update an Access database with information from incoming phone calls, faxes, and emails. + Take member inquiry calls related to pharmacy benefits, including prior authorization requests. + Maintain expert knowledge of Medicare pharmacy benefits and formularies, including applicable regulations relevant to the role. + Educate members on their specific pharmacy benefits and present options, including submission of prior authorization requests. + Process member-submitted claims accurately and efficiently. + Review requests from physicians and pharmacies for prescription drugs that are non-formulary, require prior authorization, exceed quantity or cost limits, or need assistance with online claim processing. + Assign, enter, and document prior authorizations into the appropriate claims processing system. + Answer phone calls regarding prior author To view full details and how to apply, please login or create a Job Seeker account