Pharmacy Technician II - Medicaid

Boise, ID

Ambulatory Health Care Services

About the position

Join PacificSource and help our members access quality, affordable care! Coordinate application of pharmacy services and benefits as an integral contributor on the pharmacy team. Handle pharmacy-related inquiries and communicate benefit determinations. Provide pharmacy services helpdesk support to pharmacies, providers, and members. Perform pharmacy authorization and claim processing services.

Responsibilities

• Act as principal contact regarding drug authorizations and system overrides.
• Help to resolve pharmacy services and benefits inquiries through skillful knowledge of the pharmacy claims, medical claims, and utilization management platforms.
• Initiate clinical review and decision-making of authorization requests under the guidance of clinical pharmacists.
• Effectively communicate and collaborate in a clear and concise manner to internal and external partners.
• Function as liaison with pharmacy benefit manager, pharmacies, physicians, and others in order to apply benefits.
• Consult with clinical pharmacists and other staff in determining coverage for pharmacy-related services and pharmaceuticals.
• Prepare and process member-submitted pharmacy claims in the pharmacy benefit manager's claims processing system.
• Ensure all coverage determinations are processed in a timely and accurate manner.
• Serve as primary resource to members and providers for pharmacy questions related to the health plan.

Requirements

• Minimum two years Pharmacy Technician experience.
• Minimum high school diploma or equivalent.
• Unrestricted pharmacy technician license by the Board of Pharmacy.
• Previously passed National Pharmacy Technician certification exam required.
• Good understanding of Medical Terminology required.
• Familiarity of CPT/ICD-10 codes, home infusion therapies, and specialty medications helpful.
• Ability to work under time sensitive deadlines.
• Ability to prioritize responsibilities and manage workload with direct supervision.
• Demonstrate organizational and time management skills.
• Ability to communicate effectively across all levels of the business.

Nice-to-haves

• Ability to understand and interpret Federal and State specific regulatory requirements helpful.