Pharmacy Benefit Technician

📋 Description

• Accountable for adhering to the policies and procedures established within the pharmacy department to guarantee that Members receive the appropriate medications promptly, cost-effectively, and efficiently.

• Requires proficiency in various computer applications.

• Manage inquiries from Members, pharmacies, and providers regarding pharmacy-related issues such as coverage, prior authorizations, step therapy, networks, overrides, and denial rationales.

• Assess incoming prior authorization requests and communicate with the provider's office, pharmacies, prior authorization department, or Member to clarify the purpose of the prior authorization and identify any potentially missing information.

• Input prior authorizations and formulary exception requests into the referral form.

• Review Plan policy to determine which requests should be forwarded to the clinical pharmacist team for evaluation.

• Prepare initial and benefit denial letters.

• Act as a liaison with the pharmacy benefit manager (PBM) regarding any pharmaceutical inquiries or issues that may arise.

• Serve as a resource for other departments within the health plan.

• Achieve and maintain all benchmark statistics (prior authorizations, medical claims reviews, phone interactions, approval and denial letters, and CRM volume) while in this role.

⛳️ Requirements

• Pharmacy technicians must possess at least a high school diploma or its equivalent.

• Experience in inpatient and retail pharmacy utilization, along with a comprehensive understanding of pharmacy practice, is preferred but not mandatory.

• Familiarity with computers and the capability to operate multiple programs simultaneously is essential.

• Exceptional oral and auditory communication skills are necessary for effective interoffice dialogue and Member or provider interactions.

• National certification (CPhT designation) is required, either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA).

• In South Dakota, registration is required within 30 days of the date of hire.

• Technicians registered with the South Dakota Board of Pharmacy after July 1, 2014, will be classified as a “technician-in-training” and will have two years to complete training education and obtain national certification through the Pharmacy Technician Certification Board (PTCB).

• Failure to secure National Certification within two years of registering as a “technician-in-training” will lead to termination of the position.

• Technicians registered with the South Dakota Board of Pharmacy after July 1, 2011, must obtain National Certification through the Pharmacy Technician Certification Board by July 1, 2014.

• Failure to achieve National Certification will result in termination of the position.

• Technicians registered with the South Dakota Board of Pharmacy prior to July 1, 2011, will be grandfathered in and will not be required to obtain national certification through the Pharmacy Technician Certification Board.

🏝️ Benefits

• Competitive salary and compensation package.

• Opportunities for professional development and growth.

• Comprehensive healthcare and wellness benefits.

• Supportive work environment with a focus on teamwork.