Pharmacy Technician - Pharmaceutical Systems & Policy

West Virginia University; Evansdale (WV); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

18 sick days per year

401(a) retirement savings with 6% e‑m/

Wellness programs

Job summary

West Virginia University is hiring a Pharmacy Technician in the Pharmaceutical Systems & Policy Department. The role supports Medicaid and public payer programs, reviewing claims, handling prior authorizations, and assisting providers with coverage questions.

The position requires a relevant degree or equivalent experience, strong math, and exceptional communication skills. Benefits emphasize work-life balance, with comprehensive health, retirement, and wellness programs in Morgantown.

Qualifications

• Associate's degree or equivalent.
• 0-6 months of experience with symptoms, drug properties & interactions and preventive healthcare measures.
• All qualifications must be met by the time of employment.
• Equivalent combination of education/experience will be considered.

Responsibilities

• Serve as initial contact for healthcare providers.
• Review information requests and prior authorizations; enter approved requests.
• Explain claim denials and provide resources on drug coverage.
• Perform data entry and research provider inquiries; follow guidelines.
• Communicate clearly by phone, fax, or email in a professional manner.
• Assist with program administration and prepare materials for enhanced quality.

Skills

Math skills

Independent work

Organization

Communication

Confidentiality

MS Office

English literacy

Pharmacy knowledge

Education

Associate's degree or equivalent

Tools

Microsoft Office

Job description

Job Description - Pharmacy Technician - Pharmaceutical Systems & Policy (30150)

Description

The Pharmaceutical Systems & Policy Department at West Virginia University is currently accepting applications for a Pharmacy Technician.

About the Opportunity

This position will be responsible for answering requests for information, prior authorization, or help from prescribers and pharmacy providers enrolled in the WV Bureau for Medical Services Medicaid Prescription Drug Program, Gainwell Technologies, Inc., WV Public Employees Insurance Agency (PEIA), and WVCHIP via phone or fax. This position will review prescription drug claims to determine insurance coverage of the drug or prior authorization criteria. The position also reviews pharmacy help desk calls to help pharmacies with claims that will not properly process. Incumbent will explain to the provider why a prescription drug claim is not being paid by the plan and will perform data entry if the claim can be approved. Incumbent will also provide resources to the providers to help them understand the drug coverage limitations.

We strongly believe in work-life balance and keeping time for things we love outside our work. WVU offers generous benefits, including:

• 18 sick days per year(for when you’re ill, for when you need time to care for sick family, for your own, or your family’s, regularly scheduled medical appointments. Who is family for the purpose of this leave? A lot of people in your life including immediate relatives and in-laws as well as others considered to be members of your household living under the same roof)
• 401(a) retirement savings with 6% employee contribution match, eligibility to continue health insurance, and other retiree perks. Looking for more retirement benefits information ? Check out retirement health insurance benefits, retirement income, and FAQ’s.
• Wellness programs

What You’ll Do

• Responsibilities are functional in nature and performed under supervision. Specific tasks include, but are not limited to:
  • Serves as the initial & main point of contact for healthcare providers serving the population of the WV
  • Bureau for Medical Services & WV Public Employees Insurance Agency.
  • Provides excellent customer service through interaction with pharmacies & other healthcare providers.
  • Communicates clearly & concisely over the phone, fax, or electronic mail in a professional manner.
  • Evaluates Help Desk & prior authorization requests using established guidelines and enters approved requests into computer.
  • Requests which require therapeutic judgement are referred to attending pharmacist
  • Research provider inquiries using all available resources.
  • Perform callbacks to providers' inquiries when necessary.
  • Documents all communications & required information in the appropriate database.
  • Assists Program Director/Pharmacist with administrative details of the program. Gathers, coordinates, & develops materials needed for enhanced quality of the program.
  • Responds to requests for information from state, federal, or other governmental agencies & departments, and colleges or other University affiliates.
  • Assists Program Director/Pharmacist with special projects as needed.
  • Composes correspondence requiring a high degree of knowledge & familiarity of the program.
  • Performs research or statistical work in the compilation of reports involving the administrative activities of the program

Pay Grade: PG-16

Hours: 37.5

Qualifications

• Associate's degree or equivalent
• 0-6 months of experience in the following:
  • Experience and knowledge of symptoms, drug properties & interactions, and preventive healthcare measures
• All qualifications must be met by the time of employment.
• Any equivalent combination of related education and/or experience will be considered

Knowledge, Skills, and Abilities

• Strong mathematical skills necessary to perform financial & dosage calculations.
• Demonstrated ability to work independently, exercising judgement.
• Demonstrated ability to organize information & draw logical conclusions.
• Demonstrated ability to plan, organize, and set priorities regarding the work to be accomplished.
• Demonstrated excellent oral & written communications skills. Outstanding people skills, including a positive attitude, outgoing personality, & the ability to effectively deal with all types & levels of people in a positive manner.
• Demonstrated ability to maintain confidential information.
• Skilled at using a computer & related software, including Microsoft Office (Word, Excel, PowerPoint, etc.).
• Skilled at using computer for internet data collection, electronic mail & other software.
• Ability to read and write in English.
• Ability to operate standard office equipment.
• Ability to learn scientific or specialized terminology specifically relating to Pharmacy & Medicaid programs.
• Knowledge of prescription drug information (i.e. generic & brand names, class of drugs).
• Knowledge of pharmacy operations & insurance billing processes associated with retail pharmacy operations.
• Knowledge of symptoms, drug properties & interactions, & preventive healthcare measures.
• Ability to follow guidelines & convey information in an accurate manner.
• Ability to be flexible & work in an environment with frequent rule changes.

Requirements

• Licensed pharmacy technician or have passed an equivalent examination

About WVU

West Virginia University is a place of purpose and community. We take pride in our profound impact on the state of West Virginia and are committed to the personal and professional growth of our employees.

From the groundbreaking R1 research at our flagship campus in Morgantown to the career-oriented programs at WVU Potomac State in Keyser, and the technology-intensive programs at WVU Tech in Beckley, the contributions of WVU employees resonate across the state, touching lives and shaping futures.

At WVU, you will discover a supportive community that champions work-life balance and fosters a collaborative atmosphere. Our core values — service, curiosity, respect, accountability and appreciation — unite us as Mountaineers.

Join us at West Virginia University, where your work will make a lasting impact. To learn more about WVU, visit wvu.edu.

West Virginia University is an Equal Opportunity Employer. We invite all qualified applicants regardless of race, color, religion, sex, national origin, age, disability, genetic information, or Veteran status.