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.
- Ability to understand and interpret Federal and State specific regulatory requirements helpful.
- Ability to communicate effectively across all levels of the business.
Nice-to-haves
- Experience with Microsoft Office products including Word, Excel, and Outlook.
Benefits
- Equal opportunity employer.
- Commitment to diversity and inclusion.
