Pharmacy Operations Representative – Medicaid

Jobtailor; Illinois; On-site; USD 52,000 - 76,000; Full time

Job summary

Jobtailor in the United States seeks a licensed Pharmacy Technician to support pharmacists, care coordinators, and customer service teams in resolving pharmacy-related issues including claims. The role involves collaboration with internal departments and external vendors to ensure regulatory compliance and benefit inquiries are addressed.

Ideal candidates have CPhT, a business-related degree or equivalent healthcare experience, strong communication skills, and familiarity with MS Office and drug

Qualifications

• Licensed and unrestricted Pharmacy Technician (CPhT).
• Bachelor's degree in Business or related health care field OR 4 years work experience in a pharmacy/health care/managed care industry.
• Verbal and written communication skills.
• Managed care customer service experience.
• Proficiency of MS product suite; Word, Excel, Access, and database software.
• Drug information skills.
• Handle multiple tasks and strong organizational skills.
• Retail, Hospital, Specialty Pharmacy, Pharmacy Benefits Manager, Health Plan experience (preferred).
• Telephone support to members, providers, pharmacies and groups regarding benefits (preferred).
• Support through written and digital channels (preferred).

Responsibilities

• Provide assistance to pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims.
• Work closely with internal departments and external vendors to evaluate and resolve issues.
• Support processes to ensure federal and state regulations and program requirements are met and maintained.
• Communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits.

Skills

Pharmacy Technician

CPhT

Drug information skills

Managed care customer service

Utilization Management

Clinical Services

Claims resolution

Process facilitation

Step Therapy

Prior-authorization

Verbal communication

Written communication

Organizational skills

Collaboration

Problem-solving

Multi-tasking

Education

Bachelor's degree in Business or related health care field

4 years work experience in a pharmacy/health care/managed care industry

Job description

Responsibilities

• Provide assistance to pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims
• Work closely with internal departments and external vendors to evaluate and resolve issues
• Support processes to ensure federal and state regulations and program requirements are met and maintained
• Communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits

Requirements

• Licensed and unrestricted Pharmacy Technician/Certified Pharmacy Technician (CPhT)
• Bachelor's degree in Business or a related health care field OR 4 years work experience in a pharmacy/health care/managed care industry
• Verbal and written communication skills
• Managed care customer service experience
• Proficiency of MS product suite; Word, Excel, Access, and database software
• Drug information skills
• Handle multiple tasks and strong organizational skills.
• Retail, Hospital, Specialty Pharmacy, Pharmacy Benefits Manager, Health Plan experience (preferred)
• Telephone support to include members inquiries, providers, pharmacies and groups regarding benefits (preferred)
• Support through written and digital channels (preferred)Effectively working across / collaborating with internal stakeholders such as Customer Service Team, PBM/Pharmacy, Providers, members to resolve pharmacy related gaps in care, coverage & claims submission issues (preferred)
• Facilitate process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services (preferred)

Hard Skills

• Pharmacy Technician
• Certified Pharmacy Technician (CPhT)
• Drug information skills
• Managed care customer service
• Utilization Management (UM)
• Clinical Services
• Claims resolution
• Process facilitation
• Step Therapy
• Prior-authorization

Soft Skills

• Verbal communication
• Written communication
• Organizational skills
• Collaboration
• Problem-solving
• Multi-tasking

Certifications & Qualifications

• Licensed Pharmacy Technician
• Certified Pharmacy Technician (CPhT)