Pharmacy Services Technician - Medical Drug PA Team

Cambia Health Solutions; Boise (ID); Remote; USD 10,000 - 60,000; Full time

Job summary

Join a purpose-driven team as a Pharmacy Services Technician, where your expertise in pharmaceuticals and healthcare coding will make a real difference. This role offers the opportunity to support a corporate-wide pharmacy team, tackling non-clinical issues and enhancing operational processes. You'll collaborate with healthcare professionals, ensuring seamless communication and documentation while contributing to quality initiatives. With a commitment to employee growth and community outreach, this position not only provides a competitive salary but also a chance to be part of an innovative culture that values trust and collaboration. Embrace a career that empowers you to transform lives and improve health care for all.

Benefits

Medical, dental, and vision coverage

Annual employer contribution to a health savings account

Generous paid time off and holidays

Market-leading retirement plan with company match

Paid parental time off

Award-winning wellness programs

Employee Assistance Fund

Commute and parking benefits

Qualifications

• High school diploma required; 2 years experience in pharmacy services preferred.
• Strong knowledge of medical terminology and pharmaceutical products essential.

Responsibilities

• Handle non-clinical pharmacy issues and support formulary operations.
• Communicate effectively with providers and members as needed.
• Assist in auditing and investigations of medication-related claims.

Skills

Medical terminology knowledge

Health care coding systems (ICD 10, CPT, HCPCS)

HIPAA regulations knowledge

Pharmaceutical products knowledge

General office practices

Effective interaction with health care professionals

Pharmaceutical pricing calculations

Typing skills (30 wpm minimum)

Basic computer programs skills (Word, Excel)

Organizational and planning skills

Education

High school diploma or related certificate

2 years of experience in pharmacy services

Tools

Standard business machines (calculators, copiers, faxes)

Computer programs (Word, Excel)

Job description

Pharmacy Services Technician Work from home within WA, OR, ID or UT

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia’s dedicated team of Pharmacy Technicians are living our mission to make health care easier and lives better. The Pharmacy team is a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. This function assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals.

What You Bring to Cambia: Qualifications:

• High school diploma or related certificate

• 2 years of experience as a pharmacy services technician in managed care, health insurer, pharmacy benefit manager (PBM), provider setting or other licensed pharmacy setting or equivalent combination of education and experience.

Skills and Attributes:

• Knowledge of Medical terminology, health care coding systems such as ICD 10, CPT and HCPCS and HIPAA regulations.

• Knowledge of Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.

• Knowledge of general office practices and procedures.

• Demonstrated knowledge of Grammar and techniques of business practice.

• Ability to interact effectively with a variety of health care professionals, including physicians, nurses, pharmacists, and billing staff both internally and externally.

• Demonstrate maturity, tact, diplomacy, and persuasiveness.

• Demonstrated ability to perform pharmaceutical pricing calculations.

• Ability to type 30 words per minute, 60 wpm preferred.

• Demonstrated ability to operate a variety of standard business machines including calculators, copiers, and faxes.

• Basic computer programs skills (Word, Excel, etc.).

• Ability to organize, plan, and prioritize daily workflow and projects within time constraints.

• Experience with health insurance and/or prescription benefits preferred.

What You Will Do at Cambia:

• Perform all duties as described in this document unless doing so would require clinical judgement. In any situation in which clinical judgment is necessary, the Pharmacy Services Technician will seek assistance from appropriate medical personnel.

• Responds to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, and customer service.

• Completes daily formulary operational processes, including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals.

• Prepares reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation.

• Communicates (orally and by written documentation) information and determinations to providers and members as necessary.

• Obtains and organizes drug utilization data in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants.

• Assists with auditing and investigations of medication-related claims, cases, and providers.

• Investigates and organizes workflow for claims referred to Pharmacy Services for review.

• Supports wellness and disease state management programs for Pharmacy Service and corporately.

• Contributes to and supports the corporation’s quality initiatives through process improvement teams.

The expected hiring range for a Pharmacy Services Technician is $24.00 - $29.00 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history.

The bonus target for this position is 5%. The current full salary range for this role is $19.00 - $34.40 an hour.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions.
• Up to 12 weeks of paid parental time off.
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail] .