Pharmacy Technician II

CareSource; Indiana; Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Total rewards package

Job summary

CareSource is seeking a Pharmacy Technician II to support prior authorization processes, data entry, and provider/pharmacy communications. You will review traditional and specialty requests and help resolve escalations in the pharmacy department.

Role requires strong phone and document management, familiarity with Medicaid/Marketplace, and ability to work independently or within a team. Equal opportunity employer.

Qualifications

• High School Diploma or equivalent years relevant work experience is required.
• Three (3) years retail pharmacy or hospital pharmacy experience is preferred.
• One (1) year managed care prior authorization experience is preferred.

Responsibilities

• Review prior authorization requests for traditional and specialty medications.
• Send fax communications to providers when necessary.
• Contact provider offices to follow up on failed faxes.
• Educate CareSource providers about resources outlining formulary alternatives.
• Place prior authorizations for when approval is appropriate in the prior authorization system(s).
• Initiate process for routing prior authorizations requiring review by a pharmacist.
• Answer calls from providers regarding prior authorization requests, prescription coverage and formulary issues.
• Perform outbound calls to obtain information from providers and/or pharmacies.
• Document all telephonic interaction in appropriate system(s).
• Ensure inquiries and submissions are answered within state mandated period.
• Involvement in special projects reviewed by the management team when needed.
• Answer calls and troubleshoot issues from retail and specialty pharmacies.
• Assist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questions.
• Maintain knowledge of all processes for all markets on faxes and phones.
• Adhere to all departmental and company policies and procedures.

Education

High School Diploma or equivalent

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

Job Summary

The Pharmacy Technician II is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department.

Essential Functions

• Review traditional and specialty medication prior authorization requests for the member’s pharmacy benefit submitted by providers
• Send fax communications to providers when necessary
• Contact provider offices to follow up on failed faxes
• Educate CareSource providers about resources outlining formulary alternatives
• Place prior authorizations for when approval is appropriate in the prior authorization system(s)
• Initiate process for routing prior authorizations requiring review by a pharmacist
• Answer calls from providers regarding prior authorization requests prescription coverage and formulary issues in a timely manner
• Perform outbound calls to obtain information from providers and/or pharmacies
• Document all telephonic interaction in appropriate system(s)
• Ensure all methods of inquiries (fax, e-mail, ePA) and submissions are answered within the state mandated period
• Involvement in special projects reviewed by the management team when needed
• Answer calls and troubleshoot issues from retail and specialty pharmacies
• Assist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questions
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Maintain knowledge and understanding of all processes and procedures for all markets on faxes and phones
• Adhere to all departmental and company policies and procedures
• Perform any other job duties as requested

Education and Experience

High School Diploma or equivalent years relevant work experience is required

Three (3) years retail pharmacy or hospital pharmacy experience is preferred

One (1) year managed care prior authorization experience is preferred

Competencies, Knowledge and Skills

Computer proficient with knowledge in a “Windows” environment

Beginners level Microsoft Word, Outlook, and Excel

Must type 40 words per minute (WPM)

Professional level telephone communication skills

Familiarity with medical terminology

Familiarity with medication names

Excellent communication skills when speaking to providers offices, as well as pharmacies

Ability to work independently and within a team environment

Ability to train/teach new employees within the department

Attention to detail

Familiarity of the healthcare field

Knowledge of Medicaid/Marketplace

Critical listening and thinking skills

Proper grammar usage

Time management skills

Proper phone etiquette

Customer service oriented

Decision making/problem solving

Leadership experience and skills

Licensure and Certification

Pharmacy Technician Certification is preferred

Ability to acquire state registration in multiple states, as required

Working Conditions

General office environment; may be required to sit or stand for extended periods of time Position requires the ability to work any shift between 7am and 9pm and the flexibility to work weekends and overtime, as needed

Compensation Range

$35,900.00 - $57,300.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary)

Hourly

Organization Level Competencies

Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business

This job description is not all inclusive.

CareSource reserves the right to amend this job description at any time.

CareSource is an Equal Opportunity Employer.

We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Discover what it means to be #UniquelyCareSource.