Pharmacy Tech I- Clinical Programs

WELLDYNE; United States; Remote; USD 38,000 - 56,000; Full time

Benefits offered by this job

Medical, Dental and Vision Benefits

Medical Savings Account Options with 2

401K after 90 days of employment

Employee Assistance Program

Life and Supplemental insurance

Educational Reimbursement

Paid Time Off

Career Pathing

Job summary

WellDyne is seeking a Pharmacy Tech I to support the Clinical Solutions team, handling inbound/outbound calls with members and providers and assisting with prior authorization operations. You will follow policies, maintain PHI confidentiality, and contribute to training and process improvements.

The ideal candidate has at least 2 years in pharmacy and 2 years in customer service, with strong analytical and time-management skills, proficiency in MS Office, and the ability to work both

Qualifications

• At least 2 years of pharmacy-related experience.
• At least 2 years of customer service-related experience.
• MS Office Suite knowledge and ability to learn new computer systems.

Responsibilities

• Review prior authorization requests to determine medical necessity.
• Answer questions based on clinical information submitted by providers.
• Request additional information from providers as needed for review.
• Direct denials to a clinical pharmacist for final review.
• Assist in processing appeals.
• Update clinical program trackers and communications logs.
• Ensure PA approvals are recorded accurately and timely.
• Communicate approval/denial outcomes to providers and members, per regs.
• Participate in design and build of PA and step therapy in key systems.
• Run/reports to support operations and oversight.
• Serve as SME liaison with client services.
• Participate in training and apply policies and eligibility rules.
• Maintain PHI confidentiality per state/federal law.
• Meet productivity, schedule adherence, and quality standards.
• Other duties as assigned.

Skills

Telephone communication

Verbal communication

Written communication

Time management

Teamwork

Independent work

Analytical skills

Attention to detail

Multi-tasking

Problem solving

Customer service

MS Office proficiency

Tools

MS Office Suite

Job description

Summary

Pharmacy Tech I is responsible for supporting WellManaged and other clinical solutions within the Clinical Solutions team. The technician will support inbound and outbound calls with members and providers as well as support other clinical program activities. Individuals will follow all policies and procedure related to clinical reviews. Individuals will also support PA operations and will serve as a client service liaison as it relates to prior authorization, as well as participate in training. This position requires strong analytical, strong communication skills, problem solving and decision-making skills. Individuals must have a strong attention to detail with excellent time management skills and must also be proficient in Microsoft applications.

Essential Duties and Responsibilities

• Responsible for reviewing clinical prior authorization requests based upon protocols to determine medical necessity.
• Answers questions appropriately based upon clinical information submitted by the provider.
• Requests additional information from providers as needed for review.
• Directs all prior authorization denials to a clinical pharmacist for final review.
• Assists in the process of managing appeals.
• Accountable for updating clinical program trackers to ensure accurate tracking of all clinical interventions, member communications, and provider communications.
• Ensures all prior authorization approvals are placed correctly and in a timely manner.
• Interacts with providers and members as appropriate to communicate approval and denial outcomes in compliance with state, federal, and accreditation requirements.
• Participates in design and build of prior authorization and step therapy within key systems.
• Runs and generates various reports to support operational activities and oversight
• Serves as subject matter expert liaison with client services.
• Participate in training.
• Apply appropriate policies, procedures, and eligibility and benefit policies.
• Maintains confidentiality of all PHI in compliance with state and federal law.
• Consistently meets established productivity, schedule adherence, and quality standards, while maintaining a good attendance record.
• Other duties as assigned.

Education and Experience

• At least 2 years of pharmacy related experience
• At least 2 years of customer service-related experience
• MS Office Suite knowledge (Which includes the ability to learn new and complex computer system applications)

Knowledge, Skills, and Abilities

• Strong telephone, verbal, and written communication skills
• Time Management Skills
• Teamwork and team building skills
• Ability to work independently within a team environment with little direct supervision
• Analytical skills
• Ability to remain focused and productive each day through tasks may be repetitive
• Strong attention to detail and effective follow-up skills
• Ability to multi-task
• Claim system knowledge
• PA Hub knowledge
• Positive attitude with excellent customer service mindset demonstrating WellDyneRx commitment to incredible service
• Computer proficiency to navigate required databases and operate in required software packages
• Demonstrated ability to handle problems tactfully

WellDyne Can Offer You

• Medical, Dental and Vision Benefits
• Medical Savings Account Options with Company match
• 401K after 90 days of employment
• Employee Assistance Program
• Life and Supplemental insurance
• Educational Reimbursement
• Paid Time Off
• Career Pathing

Work Environment / Physical Demands

This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.

EOE M/F/D/V