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PHARMACY TECH - HOAG CLINIC

Department:  Allied Health
Status:  Full Time
Shift:  1st

Job Summary:

The Pharmacy Technician of the refill clinic reports directly to the Pharmacy Technician Lead, is responsible to assist and process all incoming pharmacy referrals, refills, emails, chat messages and faxes related to prescription refill requests, in a team-based, high volume medical group setting. In addition, the Pharmacy Technician will also be responsible for processing prior authorization requests on both Medical and Pharmacy benefits. The Pharmacy Technician will assist in checking eligibility, coordinating pharmacy benefits, preventing any potential refill delay and follow-up for all requests, to assure they are completed in a timely manner. 

 

Essential Functions:

  • Manage incoming requests from call center, provider and referral team for new medications and medication refills.
  • Responsible for processing medication prior authorizations and script renewals for patient.
  • Ensure scripts are filled in a timely manner by coordinating with the requesting provider, following up with the Pharmacy Benefit Manager (PBM) as appropriate, and reaching out to the necessary department as needed.
  • Ensures the patient completed the necessary labs and diagnostic testing as required prior to dispensing certain medication.
  • Responsible for understanding the clinical protocols for medication refills as established by the organization
  • Ensure that the patient has attended any required provider visits and follows all authorized medication protocols.
  • Understands the insurance and healthcare benefits, submits prior authorizations to the UM department or to the PBM, and ensures that the required supporting documentation is submitted for review.
  • Adheres to the implemented refill center workflow.
  • Adapts easily to a high volume, fast pace medical group setting.
  • Manage escalated patient care issues in collaboration with the member services, providers and Case Management teams as appropriate.
  • Reports immediately to the Pharmacy Technician Lead on adverse concerns or workflow issues related to quality of care or patient care oversights.
  • Assist the quality team in any HEDIS or Quality Star measure initiatives and protocols as appropriate for medication adherence and refill measures.
  • Other duties as assigned.

 

Education, Training and Experience

Required:

  • High School Diploma or GED
  • Current National Pharmacy Technician Certification
  • 3 years’ experience as a Pharmacy Technician
  • Minimum 1-year experience working with Prior Authorizations

Preferred:

  • 3 years’ experience in third party prescription program claims adjudication
  • 2-3 years’ experience working with prior authorizations
  • Experience working in a high volume and fast paced pharmacy environment
  • Insurance benefit knowledge and understanding
  • EPIC or other EMR use or knowledge

 

Skills or Other Qualifications

Required:

  • Demonstrate a working knowledge of popular brand and generic names
  • Knowledge of drug classifications
  • Prior Authorization experience
  • Knowledge of common medical terminology
  • Understanding of national drug code
  • Understanding Clinical Protocols and Standards of Care for Medication Management Therapy
  • Strong computer skills including MS Word and MS Excel
  • Possess good communication skills and ability to work independently and in a team setting
  • Maintains a positive attitude in changing conditions
  • Detail oriented, personable, and efficient in all tasks and communication
  • Efficient in workflow, always working on a task/project
  • Well maintained organizational and prioritization skills
  • Performs all job duties with a professional appearance and attitude at all times
  • Ability to work in a fast-paced, high volume environment
  • Proficient in computer and Microsoft Office Software skills especially Excel

 

License and Certifications

Required: PTCB, CPhT

Preferred: N/A

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