This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2193665 Pharmacy Services
Technician
Looking for candidates within Idaho, but the right candidate will be
eligible for a remote role within our 4-state footprint (WA, ID, OR, and
UT).
Primary Job Purpose
The Pharmacy Services Technician is a corporate-wide technical support
resource for pharmacy benefit, reimbursement, and other drug use issues
which do not require clinical judgment. This function assists the
Clinical Pharmacy Consultants and Pharmacy Services staff with
formulary-related operations and other operational processes which
require knowledge and experience with pharmaceuticals.
Normally to be proficient in the competencies listed below:
Pharmacy Services Technician would have a high school diploma or related
certificate and five years of experience as a pharmacy services
technician in a retail, hospital, or other licensed pharmacy setting or
equivalent combination of education and experience. Pharm tech
certificate may be substituted for two years of experience.
Responsibilities:
- Performs all duties as described in this document unless doing so
would require clinical judgement. 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.
- 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.
- 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.
Minimum Requirements:
- Knowledge of medical terminology, health care coding systems such as
ICD-10, CPT and HCPCS and HIPAA regulations.
- Knowledge of pharmaceutical products, including orals, injectables,
infusion products, and chemotherapy.
- Knowledge of general office practices and procedures.
- Demo strated knowledge of grammar and techniques of business
practice.
- Ability to interact effectively with a variety of health care
professionals, including physicians, nurses, pharmacists, and
billing staff both internally and externally.
- Demonstrate maturity, tact, diplomacy, and persuasiveness.
- Demonstrated ability to perform pharmaceutical pricing calculations.
- Ability to type 30 words per minute, 60 wpm preferred.
- Demonstrated ability to operate a variety of standard business
machines including calculators, copiers, and faxes.
- Basic computer programs skills (Word, Excel, etc.).
- Ability to organize, plan, and prioritize daily workflow and
projects within time constraints.
- Experience with health insurance and/or prescription benefits
preferred.
Work Environment:
- Work primarily performed in an in-home environment.
- May be required to work overtime.
The base pay annual salary range for this job is \$18.80 -
\$34.10/hour,depending on candidate\'s geographic location and
experience.
The annual incentive payment target for this position is 5%.
Base pay is just part of the compensation package at Cambia that is
supplemented with an exceptional 401(k) match, bonus opportunity and
othe