Pharmacy Technician

Centene Corporation; New York (NY); Hybrid; USD 27,000 - 45,000; Full time

Job summary

Centene Corporation is seeking a Pharmacy Technician to support formulary management, audits and pharmacy service operations. You will review formulary requests, process changes to Health Net plans, and assist with claims data maintenance across multiple programs.

Responsibilities include auditing paid claims for discrepancies, communicating findings to pharmacies, and updating databases and company websites under guidance from Clinical Pharmacists.

Qualifications

• High School diploma or GED required.
• 1 year Pharmacy Technician experience.
• Customer Service/retail experience preferred.
• Valid Pharmacy Technician License preferred.

Responsibilities

• Reviews and processes formulary change requests from Health Net plans.
• Submits and maintains formulary change requests to Health Net’s pharmacy claims processor.
• Generates, maintains and reviews Formulary Status Grids.
• Audits and quality checks formulary status for accuracy and contract compliance.
• Assists Clinical Pharmacist with formulary database updates to the company site.
• Reviews paid claims for quantity and/or billing discrepancies.
• Corresponds with pharmacies to communicate review findings.
• Faxes inquiries to pharmacies related to review findings.
• Answers incoming calls and responds to faxes from pharmacies.
• Updates Access database with incoming phone calls, faxes and emails.
• Performs other duties as assigned.
• Complies with all policies and standards.
• May perform duties in Formulary Management, Pharmacy Audit and Recovery, and related areas.

Skills

Customer service

Pharmacy knowledge

Education

High School diploma or GED

Job description

Position Purpose

• Reviews and processes formulary change requests from Health Net plans
• Submits and maintains formulary change requests to Health Net’s pharmacy claims processor
• Generates, maintains and reviews Formulary Status Grids
• Uses reports to perform audits and quality checks on the current formulary status for accuracy and contract compliance
• Assists Clinical Pharmacist with formulary database maintenance and updates to company web site

Pharmacy Audit And Recovery

• Performs a variety of assignments required for pharmacy audit and recovery functions
• Reviews paid claims for quantity and/or billing discrepancies. Corresponds with pharmacies as needed to communicate review finding
• Faxes inquiries to pharmacies related to review findings
• Answers in-coming calls and responds appropriately to faxed correspondence from pharmacies
• Updates Access database with incoming phone calls, faxes and e-mails
• Performs other duties as assigned
• Complies with all policies and standards

The Pharmacy Technician may perform duties in one or more of the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D/Part B, Appeals, Medicare Part D Operations and State Health Programs Pharmacy Operations or Prior Authorization.

Using established company guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits. The technician researches and resolves questions, problems or issues. May consult with Clinical Pharmacists or Regional Medical Director on related issues.

Education/Experience

High School diploma or GED required. 1 year Pharmacy Technician experience. Customer Service/retail experience preferred

License/Certification:

Valid Pharmacy Technician License preferred.

Pay Range: $19.43 - $32.98 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act