Pharmacy Benefit Technician

40000 Sanford Health Plan; United States; On-site; USD 25,000 - 40,000; Full time

Job summary

Sanford Health is seeking a Pharmacy Technician to support members and providers by handling calls regarding coverage, prior authorizations, and pharmacy networks. The role requires processing authorizations, communicating with PBMs, and supporting multiple medical software programs.

The technician will review requests, generate denial or approval letters, and contribute to performance benchmarks while maintaining accuracy and timeliness in a fast-paced environment.

Qualifications

• Pharmacy technicians must have a minimum of a high school diploma or equivalent.
• Familiarity with computers and ability to work with multiple programs at the same time.
• National certification through PTCB or NHA is required or pursued.

Responsibilities

• Handle calls from Members, pharmacies, and providers regarding coverage, prior authorization, and network issues.
• Review and clarify prior authorization requests and enter authorizations into referral forms.
• Serve as liaison with the pharmacy benefit manager (PBM) for pharmaceutical questions.
• Meet benchmark statistics for prior authorizations, reviews, and CRM activity.

Skills

Multitasking

Phone support

Communication skills

Computer proficiency

Education

High school diploma or equivalent

CPhT certification

Tools

Pharmacy software systems

Job description

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. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary Range: $18.00 - $29.00 Union Position: No Department Details

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.

Job Description

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 have 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.

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 1-877-949-5678 or send an email to [e-mail].

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. Headquartered in Sioux Falls, South Dakota, the organization has 53,000 employees and serves over 2 million patients and nearly 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes a network of 56 hospitals, 288 clinic locations, 147 senior care communities, 4,000 physicians and advanced practice providers and nearly 1,500 active clinical trials and studies. The organization’s transformational virtual care initiative brings patients closer to care with access to 78 specialties. Learn more about Sanford Health’s commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News. Good Samaritan, one of the nation’s largest nonprofit providers of senior care and services, is committed to transforming the aging experience through innovation, compassion and personalized care. As part of Sanford Health, an integrated nonprofit health system headquartered in Sioux Falls, South Dakota, Good Samaritan serves 10,000 seniors and offers access to a full continuum of care, including 94 rehabilitation and skilled nursing centers, 56 assisted living and memory care facilities, 44 independent living locations and 37 home health and hospice agencies. The senior care provider delivers services across the upper Midwest, with 70% of residents living in rural communities. Learn more about Good Samaritan’s mission and commitment to delivering high quality senior care in rural America at good-sam.com.