Responsible for following policies and procedures set within the pharmacy department to ensure that Members obtain appropriate medications in a timely, cost-effective, and efficient manner.
Requires use of and proficiency in multiple computer programs.
This job involves a significant amount of time on the telephone handling calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale.
Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member (depending on where the request originates) to clarify the intent of the prior authorization and identify any potential missing information.
Enter prior authorizations and formulary exception requests into referral form.
Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review.
Will complete initial and benefit denial letters.
Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise.
Serve as a resource for other departments within the health plan.
Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.

Pharmacy technicians must have a minimum of a high school diploma or equivalent.
Experience with inpatient and retail pharmacy utilization, as well as a broad knowledge of pharmacy practice is preferred, but not required.
Familiarity with computers and ability to work with multiple programs at the same time is required.
Must have excellent oral and auditory skills for productive interoffice dialogue and Member or provider interactions.
Must be nationally certified (CPhT designation), either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA).
South Dakota: Registration required within 30 days from the date of hire.

Pharmacy Benefit Technician

Key skills