Pharmacy Benefit Technician

Good Samaritan Society; Sioux Falls (SD); Hybrid; USD 25,000 - 40,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k) retirement plan

Time off

Job summary

Sanford Health is seeking a Pharmacy Technician to support the pharmacy department by handling calls from Members, pharmacies and providers to address coverage and prior authorization questions. You will enter requests, perform formulary reviews, and liaise with the PBM and clinical pharmacist team.

This role requires strong computer skills, proficiency in multiple programs, and excellent verbal communication to ensure timely, cost-effective service for Members.

Qualifications

• High school diploma or equivalent required.
• Experience with inpatient and retail pharmacy utilization preferred.
• Proficiency with multiple computer programs and software.
• Excellent oral and auditory communication for member/provider interactions.

Responsibilities

• Handle calls from Members, pharmacies, and providers regarding coverage, prior authorization, and denial rationale.
• Enter prior authorizations and formulary exception requests.
• Coordinate with PBM and clinical pharmacist team for reviews.
• Draft initial and benefit denial letters.
• Maintain benchmark statistics for analytics and CRM volume.

Skills

Phone support

CRM software

Multitask across programs

Verbal communication

Education

CPhT certification (PTCB/NHA)

Job description

Careers With Purpose

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

• Facility: Gss National Campus
• Location: Sioux Falls, SD
• Address: 4800 W 57th St, Sioux Falls, SD 57108, USA
• Shift: 8 Hours - Day Shifts
• Job Schedule: Full time
• Weekly Hours: 40.00
• Salary Range: $18.00 - $29.00

Job Summary

Responsible for following policies and procedures set within the pharmacy department to ensure that Members obtain appropriate medications in a timely, cost-effective, and efficient manner. Requires use of and proficiency in multiple computer programs. This job involves a significant amount of time on the telephone handling calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale. Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member (depending on where the request originates) to clarify the intent of the prior authorization and identify any potential missing information. Enter prior authorizations and formulary exception requests into referral form. Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review. Will complete initial and benefit denial letters. Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise. Serve as a resource for other departments within the health plan.

Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.

Qualifications

Pharmacy technicians must have a minimum of a high school diploma or equivalent.

Experience with inpatient and retail pharmacy utilization, as well as a broad knowledge of pharmacy practice is preferred, but not required. Familiarity with computers and ability to work with multiple programs at the same time is required. The ability to work with multiple software programs concurrently allows a Pharmacy Benefits Technician to deliver the most accurate information to the Member or provider in a timely fashion. Must have excellent oral and auditory skills for productive interoffice dialogue and Member or provider interactions.

Must be nationally certified (CPhT designation), either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA).

South Dakota: Registration required within 30 days from the date of hire. Technicians registered with South Dakota Board of Pharmacy after July 1, 2014 will be registered as a “technician-in-training” and will have two years to complete training education and national certification through the Pharmacy Technician Certification Board (PTCB). Failure to obtain National Certification within two years of registering as a “technician-in-training” will result in termination of position. Technicians registered with the South Dakota Board of Pharmacy after July 1, 2011 will be required to obtain National Certification through the Pharmacy Technician Certification Board by July 1, 2014. Failure to obtain National Certification will result in termination of position. Technicians registered with South Dakota Board of Pharmacy before July 1, 2011 will be grandfathered in and not require national certification through Pharmacy Technician Certification Board.

Benefits

Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [e-mail] .

Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

• Req Number: R-0276602
• Job Function: Health Plan
• Featured: No