Medicare Pharmacy Technician - PBM Claims & PA Support

Alohacare; Honolulu (HI); On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

401k

Referral Bonus

Pre-tax Transportation

Parking

Job summary

AlohaCare seeks a Pharmacy Technician to support Medicare operations and PBM activities within our Hawaii program. The role involves assisting with Prior Authorization, coverage determinations, appeal/grievance processes, and formulary-related administrative duties.

Ideal candidates have at least two years of pharmacy experience, can work independently, and thrive in a fast-paced environment with strong data accuracy and time-management skills. Competitive benefits and a collaborative team await.

Qualifications

• Minimum of 2 years of experience in pharmacy.
• Ability to type 45 words per minute.
• Able to work independently with minimal supervision.
• Able to work in a fast-paced environment and manage multiple projects.

Responsibilities

• Oversee Medicare Part D/B PBM operations and audit reports.
• Resolve Part D/B claim issues with PBM operations team.
• Test case build and review for annual Medicare plan go-live.
• Review daily Medicare rejected claims and outreach to pharmacies.
• Process prior authorization/coverage determinations in a timely manner.
• Ensure compliance with CMS, Med-QUEST Hawaii, and NCQA turnaround times.
• Assist with Medicare appeals and grievances prep.
• Support formulary management and compliance tasks.
• Maintain confidentiality and learn PBM reporting tools.

Skills

Typing 45 WPM

Independent work

Time management

Attention to detail

Multi-tasking in fast-paced env

Education

Two years pharmacy experience

Tools

QMACS

PBM platforms

MS Office Suite

Job description

AlohaCare seeks a Pharmacy Technician to support Medicare operations and PBM activities within our Hawaii program. The role involves assisting with Prior Authorization, coverage determinations, appeal/grievance processes, and formulary-related administrative duties.

Ideal candidates have at least two years of pharmacy experience, can work independently, and thrive in a fast-paced environment with strong data accuracy and time-management skills. Competitive benefits and a collaborative team await.