Remote Managed Care Pharmacy Tech – Prior Authorization

Excellus BCBS; United States; Remote; USD 29,000 - 46,000; Full time

Job summary

Excellus BCBS in the United States is seeking a Managed Care Pharmacy Technician to support member and client pharmacy benefits, including prior authorization and formulary management. You will handle live calls with members, physicians, and pharmacists and assist with data entry, reporting, and benefit inquiries.

The role includes on-call/holiday rotations and potential remote work on a case-by-case basis, under supervision of a licensed pharmacist.

Qualifications

• High school diploma with a minimum of two years’ experience in health-related field is required.
• Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist background strongly preferred.
• Basic understanding of medical terminology and diagnosis codes.
• Proficient with Microsoft Office suite.

Responsibilities

• Review medical exception requests based on pharmacists' algorithms.
• Review clinical documentation for prior authorization requests.
• Assist with data entry and monitoring member profiles for prior authorization and ad hoc reports.
• Provide information by telephone to physicians and pharmacists regarding initiatives involving member prescriptions.
• Provide real time authorization certification of requests for prescription medications for vacation supplies, duplication of therapy overrides, medication synchronization requests and package size issues.
• Implement formulary utilization management tools (prior authorization, quantity limits, step therapy, dose optimization, age/gender restrictions).
• Work with internal and external customers to identify, analyze and solve difficult situations including system issues relative to the Pharmacy benefit.
• Research and resolve issues related to mail-order service, specialty pharmacy, or pharmacy claims processed in the Facets system at the Plan.
• Provide backup coverage to Pharmacy Benefits Team for the pharmacy phone queue as needed.
• Monitor and troubleshoot the PBM interfaces for eligibility, claims, and formulary issues; conduct testing as necessary.
• Monitor production and quality improvement; establish productivity and quality standards with management.
• Attend staff meetings and in-service programs; rotate on-call responsibilities.
• Perform other duties as assigned.

Skills

Communication skills

Verbal communication

Customer service orientation

Independence

Problem solving

Education

High school diploma

Associates degree

Pharmacy Technician certification (CPhT)

LPN/Medical Assistant background

Tools

Microsoft Office

Facets system

Job description

Excellus BCBS in the United States is seeking a Managed Care Pharmacy Technician to support member and client pharmacy benefits, including prior authorization and formulary management. You will handle live calls with members, physicians, and pharmacists and assist with data entry, reporting, and benefit inquiries.

The role includes on-call/holiday rotations and potential remote work on a case-by-case basis, under supervision of a licensed pharmacist.