Pharmacy Technician

$42,328 - $42,328/Yr

Bcvs Group - Buffalo, NY

Full-time - Entry Level

Remote - Buffalo, NY

About the position

The Pharmacy Technician position involves performing initial processing and review of prior authorization requests for pharmacy and medical specialty drugs. The role requires expertise in pharmacy management policies and procedures, and the technician acts as a resource for staff regarding member benefits and health plan functions. This position is fully remote but requires local residency within the Excellus footprint.

Responsibilities

• Conduct initial level medication prior-authorization and exception reviews.
• Route cases to the pharmacist/medical director for final determination.
• Issue verbal and written member notifications as required.
• Review and interpret prescription and medical benefit coverage across all lines of business.
• Develop and implement process improvements to increase efficiency in the review process.
• Work with providers and clinical staff to determine case approval criteria.
• Contact pharmacies and physician offices for clarification on prior authorization requests.
• Act as a lead troubleshooter for pharmacy help desk and claims processors.
• Ensure appropriate authorization entry across all lines of business.
• Perform system testing for upgrades and enhancements to the care management system.
• Serve as a subject matter expert for pharmacy and medical drug authorizations.
• Triages prior authorization workflow and monitors compliance deadlines.
• Provide phone coverage for incoming calls related to the UM process.
• Maintain knowledge of health plan contracts and procedures.
• Track and report department performance against benchmarks.

Requirements

• High school diploma or GED required.
• Minimum of two years' experience in a health-related field.
• Pharmacy Technician certification (CPhT) preferred.
• Experience in prior authorization processes is required.

Nice-to-haves

• Associates degree preferred.
• LPN or Medical Assistant/Technologist background strongly preferred.

Benefits

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Referral program
• Vision insurance