Pharmacy Technician – Specialty

📋 Description

• Acts as the primary contact for members and providers regarding specialty pharmacy benefit information, prior authorization inquiries, and navigation assistance.

• Before medication delivery, assists members enrolled in specialty management programs by coordinating necessary prior authorizations with the UM team, facilitating prescription fulfillment with specialty pharmacy partners, enrolling them in patient assistance programs, and addressing billing inquiries. After medication delivery, follows up with members to ensure satisfaction, connects them with a pharmacist for any clinical questions, and organizes future refills.

• Addresses inquiries from members, human resources departments, pharmacies, and providers about specialty distribution, benefit design, formulary coverage, medication costs, prior authorization criteria, claims processing, and copay/patient assistance, ensuring that all questions and issues are resolved.

• Collaborates with Specialty Clinical Pharmacists on patient and provider outreach efforts, which includes scheduling appointments between members and pharmacists, enrolling members in copay or patient assistance programs, providing medication adherence support, and handling other administrative duties.

• Aids in meeting all operational and productivity standards, which may involve conducting quality reviews of calls, chats, and documentation notes to identify areas for enhancement.

• Ensures compliance with regulatory and privacy standards consistently.

• Provides assistance to other teams within Clinical Operations, including utilization management and navigation.

⛳️ Requirements

• Associate’s or Bachelor’s degree is preferred.

• 1-2 years of experience as a pharmacy technician in a Specialty pharmacy, PBM, pharmacy department of a health plan, or a comparable managed care environment.

• Must hold an active Certified Pharmacy Technician (CPhT) certification.

• Detail-oriented, adaptable, a critical thinker, empathetic, with the ability to thoroughly investigate issues to reach the true root cause and resolution, and a passion for enhancing the patient’s healthcare experience while providing a concierge level of service.

• Familiarity with pharmacy claims adjudication and benefit designs/terminology, along with the ability to multitask, prioritize work, and work independently.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with company matching.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and continuing education.

• Employee discounts on various services and products.