Medicare Pharmacy Technician – PBM & Claims Support

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

Job summary

AlohaCare is seeking a Pharmacy Technician to support Medicare operations delegated to our PBM. You will handle daily Medicare claims, assist with prior authorizations and coverage determinations, and respond to drug-related inquiries for ACAP plans.

The role requires high school education, at least 2 years in pharmacy, and strong communication skills. Proficiency with PBM systems and Microsoft Office is beneficial.

Qualifications

• High school diploma or equivalent.
• Minimum of 2 years of experience in pharmacy or an equivalent combination of education and experience.
• Ability to type 45 words per minute (WPM).
• Strong communication and customer service skills; effective written and oral communication.
• Ability to work independently and manage multiple projects in a fast-paced environment.

Responsibilities

• Oversight of PBM operations related to Medicare Part D and Part B delegated operations.
• Resolve Part D/B claim issues with PBM operations team.
• Test case build and claim testing for annual Medicare plan go-lives and launches.
• Proactive outreach to pharmacies to explain claim edits and coverage options.
• Assist in reviewing and processing PA/CD requests with timely adherence to CMS and NCQA guidelines.

Skills

Typing speed

Communication

Interpersonal skills

Time management

Education

High school diploma or equivalent

College degree in science-related field

Tools

Microsoft Word

Excel

Outlook

PowerPoint

Job description

AlohaCare is seeking a Pharmacy Technician to support Medicare operations delegated to our PBM. You will handle daily Medicare claims, assist with prior authorizations and coverage determinations, and respond to drug-related inquiries for ACAP plans.

The role requires high school education, at least 2 years in pharmacy, and strong communication skills. Proficiency with PBM systems and Microsoft Office is beneficial.