Patient Care Specialist - Certified Pharmacy Technician

Carepoint Healthcare LLC; Illinois; On-site; USD 40,000 - 60,000; Full time

Job summary

Carepoint Healthcare LLC in Illinois seeks a qualified Pharmacy Technician to join our team. Active license and certification required; must have experience with major PBMs and insurance plans.

You will interpret medical charts, translate them into prior authorization requests, navigate Cover My Meds, and coordinate with patients and providers to gather necessary information and meet deadlines. You will understand ICD-10 codes, read pharmacy scripts, and ensure accurate, timely submissions while

Qualifications

• Active pharmacy tech license required.
• Active certification (PTCB/ExCPT or grandfathered) required.
• Experience with major insurances (PBMs) such as Aetna, BCBS, United, Caremark, ESI.
• Translate medical charts into prior authorization format.
• Understand pharmacy benefits and deductibles.
• Familiarity with ICD-10 codes and usage.
• Read/translate pharmacy scripts and related documents.
• Must be employed at least 6 months with the organization.

Responsibilities

• Call patients and providers to obtain clinical information for prior authorization.
• Efficiently fill out prior authorization forms with required details.
• Follow up with insurance on outcomes and submission deadlines.
• Be detail oriented in all documentation and submissions.
• Reply to sales inquiries and team inquiries with updates.
• Complete prior authorizations within a 14-day window as directed.
• Maintain perfect attendance and rotate shifts to cover operating hours.

Skills

Chart interpretation

Prior authorizations

Pharmacy benefits

ICD-10 codes

Cover My Meds

Education

Active Pharmacy Technician License

Active Pharmacy Technician Certification (PTCB/ExCPT/Grandfathered)

Tools

Cover My Meds

Job description

Job Description

Qualifications:

Active Pharmacy Technician License required

Active Pharmacy Technician Certification required (PTCB, ExCPT or Grandfathered)

1. Experience with ALL Major insurances (PBM)
2. Aetna
3. BCBS (Prime)
4. United healthcare (optum)
5. Caremark
6. ESI (express scripts)

Able to read, understand and translate medical charts into the prior authorization format.

Understand Pharmacy Benefits and Deductibles.

Understands diagnosis codes: icd10 codes and how to better utilize them.

Can properly navigate through Cover My Meds to properly fill out forms with medical chart info or Patient medical history.

Able to read and translate Pharmacy scripts.

Must be employed at least 6 months with the organization.

Responsibilities

Calling patients and providers to obtain clinical information needed to complete prior authorization if none provided on script or original fax.

Effectively and efficiently fill out prior authorization forms without missing details.

Following up with insurance for outcomes of the prior authorizations based on submission date and ability to stay on task based on required. completion date.

Need to be detail oriented.

Replying to sales inquiries and inquiries from team members to provide updates or handling customer service calls based on status or doctors' office calling to update or provide requirements.

Completing prior authorizations within a 14-day time frame or earlier based on supervisors’ expectations.

Must meet perfect attendance and able to rotate through shifts to allow a team member to always be available during hours of operation.