Key skills
CommunicationTime Management
About this role
Role Overview
- Reviews rejected pharmacy claims for appropriateness.
- Becomes a pharmacy claim processing subject matter expert and triages claims issues.
- Assist with resolution of rejected pharmacy claims via provider and/or pharmacy outreach.
- Compiles, interprets, documents, and tracks findings from pharmacy claims monitoring data.
- Becomes subject expert with Medicare Part D policies and procedures.
- Reviews Part D transition claims reports.
- Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs.
- Supports medical pharmacy prior authorizations (Part B).
- Supports Medicare Part D Customer Service call center questions and issues received from members, pharmacies, and providers.
- Supports compliance functions and requests, including support of the pharmacy department during CMS (Centers for Medicare and Medicare Services) audits when applicable.
- Supports quality programs including STARS.
- Conducts retrospective claims reviews.
Requirements
- High school diploma, GED, or equivalent
- Current Certified Pharmacy Technician License in good standing
- 1+ years Pharmacy Technician or retail pharmacy experience or the knowledge, skills, and abilities to succeed in the role
- Flexible with the ability to consistently meet deadlines and adapt to a changing work environment
- Strong planning, time management, and organizational skills
- Team player with a positive attitude
- Strong professional verbal and written communication skills
- Basic PC skills, including Microsoft Excel, Word, and Outlook
- Preferred 2+ years of experience in retail pharmacy
- 2+ years of Pharmacy Technician experience
- Part D health plan or pharmacy benefit management experience
- Certified Pharmacy Technician License
Benefits
- Medical, Vision and Dental Plans
- Tax-Advantage Savings Accounts (FSA & HSA)
- Life Insurance and Disability Insurance
- Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
- Employee Assistance Program
- 401k with company match
- Employee Resource Groups
- Employee Discount Program
- Learning and Development Opportunities
- And much more...