Pharmacy and Drug Rebate Services, Technician

Gainwell Technologies; Wellsburg District (WV); On-site; USD 36,000 - 51,000; Full time

Benefits offered by this job

401(k) match

Health benefits

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies is seeking an experienced Pharmacy Technician for its PBM clinical and technical call center. You will handle inbound/outbound calls, process prior authorizations, and assist members and providers with inquiries, while maintaining PHI security and compliance.

The role requires active registration or certification within 12 months, 2 years' relevant experience, and proficiency with Microsoft Office. Salary ranges and benefits reflect the U.S.

Qualifications

• Active pharmacy technician registration with a Board of Pharmacy or certified technician from an accredited program (PTCB, ExCPT, etc.) or must obtain certification within 12 months.
• 2 years of relevant experience as a pharmacy technician in retail pharmacy, hospital pharmacy, managed care, insurance, or PBM.
• High school diploma or GED.
• Proficient with Microsoft Office and basic computer skills.

Responsibilities

• Answer incoming calls and make outgoing calls for members, medical providers, or pharmacy providers.
• Process prior authorization requests within required time frames.
• Communicate with providers about status of authorizations and inquiries.
• Help members/providers understand pharmacy claims status, coverage rules, and plan benefits.

Skills

Communication skills

Attention to detail

Willingness to learn

Basic math

Microsoft Office

Education

HS diploma or GED

Tools

Pharmacy software

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Pharmacy Technician for the PBM clinical and technical call center is expected to be a subject matter expert in areas of pharmacy knowledge as well as call center operations. Duties will include, but are not limited to, answering incoming calls, and making outgoing calls for members, medical providers, or pharmacy providers, appropriate processing of prior authorization requests, tracking productivity, and assisting members and providers with inquiries through other media platforms as needed (fax, web, e-mail).

Your role in our mission

• Remain compliant with all PHI protocols and requirements including the handling of company confidential data according to policy and guidelines. Adheres to existing security policies and procedures.
• Process submitted prior authorization requests within the required time frame mandated by the State client
• Completion of approval process for prior authorizations where all criteria is met, and clinical judgement of a pharmacist is not required
• Complete necessary communication with providers regarding status of their authorization submission or any other inquiries
• Assist member and providers in understanding pharmacy claims status, reject reasoning, drug coverage rules, plan benefits, and assist with instructions on steps they may need to take as applicable.
• Follow standard operating procedures to receive incoming calls and use learned knowledge and resources to resolve the call on initial contact
• Provide a positive experience and clear communication with members and providers
• Complete outreach to providers to obtain information when required
• Appropriately document all inquiries received via phone, fax, or email for members or providers
• Provide a high level of customer care with our members and providers
• Meet all department requirements, goals, productivity targets, and performance expectations
• Complete all tasks assigned within regulatory guidelines
• Actively identify areas of inefficiencies and provide innovative suggestions to leadership to keep processes current
• Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements.
• Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area. Demonstrates knowledge and skill in assigned work processes.
• Complete any additional job-related tasks as requested

What we're looking for

• Must be at least 18 years of age
• High school diploma or GED required
• Active pharmacy technician registration with a Board of Pharmacy or certified pharmacy technician from accredited program (PTCB, ExCPT, etc.) or must obtain certification within 12 months
• 2 years of relevant experience as a pharmacy technician in retail pharmacy, hospital pharmacy, managed care, insurance, or pharmacy benefit management
• Knowledge of Microsoft office applications, e-mail, and computer applications required

What you should expect in this role

• Effective communication skills with internal and external clients, verbally and written
• Balance's accuracy, quality, and efficiency in all tasks
• A willingness and ability to learn internal systems/processes/programs, as needed
• Basic math skills
• Familiarity with medication names and medical terminology
• General computer knowledge including Microsoft Office, use of the internet, and email is required

The pay range for this position is $35,900.00 - $51,300.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.