Pharmacy Technician - Appeals

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 40,000 - 55,000; Full time

Job summary

A large healthcare organization is hiring for a Pharmacy Technician - Appeals to manage pharmacy authorization requests. This full-time remote position requires a high school diploma and 3 years of pharmacy technician experience. Responsibilities include building cases, evaluating requests, and maintaining high accuracy in decision documentation. The role emphasizes quality control and effective communication with customers and healthcare providers.

Benefits

Subsidized health plans

401k retirement savings plan with company match

Paid Time Off (PTO)

Education Assistance

Qualifications

• 3 years pharmacy technician experience required.
• Registered Pharmacy Technician with applicable state Board of Pharmacy.
• Certified Pharmacy Technician is required.

Responsibilities

• Set up cases for pharmacy authorization requests.
• Maintain timely and accurate processing of authorization requests.
• Participate in quality control and improvement activities.

Skills

Working knowledge of pharmaceutical claims, language, drug usage and generic substitution practices

Good judgment

Customer service and organizational skills

Analytical or critical thinking skills

Attention to detail

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

We are currently hiring for a Pharmacy Technician - Appeals to join BlueCross BlueShield of South Carolina. In this role, you will be responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. You will maintain timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit Manager (PBM) to resolve issues that may arise in the provision of pharmacy services. You will process determination letters and document decisions using indicated protocol or clinical guidelines. You will participate in quality control and/or quality improvement activities.

Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST and will be fully remote. The candidate will be asked to report on-site occasionally for trainings, meetings, or other business needs.

What You\'ll Do

• Receives and builds cases in the various applications for pharmacy authorization requests. Under Pharmacist guidance and per company policies/guidelines and established criteria sets, reviews, evaluates and authorizes approval of pharmacy requests. Requests additional information from providers including confidential medical history and prior drug therapy, in order to properly evaluate the request. Determines appropriateness for medications. Processes determination letters and communicates decision to providers and/or members ensuring timeliness and accuracy. Researches, resolves and documents outcomes in the pharmacy system. Communicates selected authorization criteria, pharmacy benefit coverage, formulary alternatives and/or Pharmacy Management program policies and procedures to pharmacy providers, members and internal contacts. Conducts research necessary to make thorough/accurate basis for each determination made.
• Loads authorization into the system and ensures the clinical determination is documented accurately into the system for all levels of care. Utilizes allocated resources to back up review determinations. Completes all assigned work within established timeliness guidelines.
• Identifies and makes referrals to appropriate staff (Pharmacist, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Escalates requests to Pharmacist when request requires extensive clinical review.
• Establishes and maintains effective relationships with providers, members and internal contacts. Responds appropriately to inquiries received from providers, members and internal contacts. Researches and resolves issues using the appropriate reference material.
• Participates in quality control and/or quality improvement activities in support of the corporate and team-based objectives. Participates in all Required Licenses and Certificates.

To Qualify for This Position, You\'ll Need the Following

• Required Education: High School Diploma or equivalent
• Required Work Experience: 3 years pharmacy technician experience
• Required Skills and Abilities: Working knowledge of pharmaceutical claims, language, drug usage and generic substitution practices
• Good judgment
• Demonstrated customer service and organizational skills
• Demonstrated proficiency in spelling, punctuation, and grammar skills
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion
• Attention to detail and the ability to handle multiple demands and balance multiple priorities in a fast-paced environment
• Ability to remain in a stationary position and operate a computer
• Required Software and Other Tools: Microsoft Office
• Required Licenses and Certificates: Registered Pharmacy Technician with the applicable state Board of Pharmacy and Certified Pharmacy Technician

We Prefer That You Have the Following

• Preferred Work Experience: 3 years-pharmacy experience in managed care setting or PBM

Our Comprehensive Benefits Package Includes the Following

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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