Remote Pharmacy Technician — Formulary & Audit Specialist

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

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.