Managed Care Pharmacy Technician: Prior Authorization & Benefits

Excellus BCBS; City of Albany (NY); À distance; USD 29 000 - 46 000; Plein temps

Avantages offerts par ce poste

Remote work option

Résumé du poste

Excellus BCBS is seeking a Managed Care Pharmacy Technician to support CDPHP initiatives. The role involves handling live calls with members, physicians and pharmacists, explaining benefits and formulary coverage, and assisting with prior authorization under supervision.

You will review medical documentation, assist with data entry for authorizations, and provide guidance on pharmacy matters. The position requires strong communication skills and a detail‑oriented approach.

Qualifications

• High school diploma required; 2+ years in health-related field preferred.
• CPhT certification or LPN/Medical Assistant background strongly preferred.
• Basic understanding of medical terminology and diagnosis codes.

Responsabilités

• Review medical exception requests based on algorithms created by pharmacists.
• Review clinical documentation against applicable criteria for prior authorization approval.
• Assist with data entry and monitoring/researching member profiles for prior authorization and ad hoc reports.
• Provide information via telephone to physicians and pharmacists regarding initiatives involving member prescriptions.
• Provide real time authorization certification of requests for prescription medications for vacation supplies, duplication of therapy overrides, medication synchronization requests and package size issues.
• Implement formulary utilization management tools (prior authorization, quantity limits, step therapy, dose optimization, age/gender restrictions).
• Work with internal and external customers to identify, analyze and solve difficult situations including system issues relative to the Pharmacy benefit.
• Research and resolve issues related to mail-order service, specialty pharmacy, or pharmacy claims processed in the Facets system at the Plan.
• Provide backup coverage to Pharmacy Benefits Team for the pharmacy phone queue line as needed.
• Monitor and troubleshoot the Pharmacy Benefit Management (PBM) and other pharmacy interfaces for eligibility, claims, and formulary issues. Conduct testing of the interfaces as necessary.
• Monitor production and quality improvement. Work with management and staff to ensure quality effort that supports the Pharmacy department standards.
• Attend staff meetings and in-service programs as requested.
• Perform rotating on-call responsibilities including holidays/evenings.
• Work additional hours as needed in order to meet turnaround time responsibilities.
• The employee agrees to comply with CDPHP’s Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer.
• Perform other duties as assigned.

Connaissances

Pharmacy technician certification (CPh

Formation

High school diploma

Associate's degree preferred

Description du poste

Excellus BCBS is seeking a Managed Care Pharmacy Technician to support CDPHP initiatives. The role involves handling live calls with members, physicians and pharmacists, explaining benefits and formulary coverage, and assisting with prior authorization under supervision.

You will review medical documentation, assist with data entry for authorizations, and provide guidance on pharmacy matters. The position requires strong communication skills and a detail‑oriented approach.