Managed Care Pharmacy Tech: Prior Authorization & Benefits

Excellus BCBS; City of Rochester (NY); Presencial; USD 29.000 - 46.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work possible

Descripción de la vacante

Excellus BCBS seeks a Managed Care Pharmacy Technician to support pharmacy benefits optimization, respond to live calls from members, physicians, and pharmacists, and assist with prior authorization work under supervision of a licensed pharmacist.

The role includes implementing formulary utilization tools, monitoring PBM interfaces, and participating in after-hours coverage. Requires CPhT certification or related background and strong communication skills.

Formación

• High school diploma or equivalent; two years in health-related field preferred.
• Associates degree preferred.
• Pharmacy Technician certification (CPhT), LPN or Medical Assistant background preferred.
• Basic understanding of medical terminology and diagnosis codes.
• Knowledge of prescription and medical benefits and utilization review processes.
• Proficient with Microsoft Office.
• Strong verbal and written communication.
• Able to work independently and handle on-call responsibilities.

Responsabilidades

• Review medical exception requests based on pharmacist-created algorithms.
• Assess documentation to approve prior authorization requests.
• Enter data and generate reports for member profiles and requests.
• Answer phone inquiries from physicians and pharmacists regarding initiatives.
• Provide real-time authorization for medications (vacation supplies, therapy overrides, etc.).
• Implement formulary tools (prior authorization, quantity limits, step therapy, etc.).
• Collaborate with internal/external customers to resolve system and benefit issues.

Conocimientos

Medical terminology

Diagnosis codes

Utilization review

Microsoft Office

Communication skills

Problem solving

Prior authorization experience

Independent work

On-call support

Educación

High school diploma

Associates degree

Pharmacy Technician certification (CPhT)

Herramientas

Facets system

Descripción del empleo

Excellus BCBS seeks a Managed Care Pharmacy Technician to support pharmacy benefits optimization, respond to live calls from members, physicians, and pharmacists, and assist with prior authorization work under supervision of a licensed pharmacist.

The role includes implementing formulary utilization tools, monitoring PBM interfaces, and participating in after-hours coverage. Requires CPhT certification or related background and strong communication skills.