Cambia Health Solutions Hiring for Pharmacy Services Technician – R-3914_40483885656_2-4185 at Coeur d’Alene, Idaho Full Time

This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2017598 Pharmacy Services
Technician

Remote within WA, OR, ID or UT

Primary Job Purpose

The Pharmacy Services Technician is a corporate-wide technical support
resource for pharmacy benefit, reimbursement, and other drug use issues
which do not require clinical judgment. This function assists the
Clinical Pharmacy Consultants and Pharmacy Services staff with
formulary-related operations and other operational processes which
require knowledge and experience with pharmaceuticals.

General Functions and Outcomes

• Performs all duties as described in this document unless doing so
  would require clinical judgement. In any situation in which clinical
  judgment is necessary, the Pharmacy Services Technician will seek
  assistance from appropriate medical personnel. Appropriate medical
  personnel will be available for support during normal business
  hours.
• Responds to non-clinical pharmacy issues from providers, pharmacy
  services staff, case managers, preauthorization nurses, ENCC
  personnel, and government programs personnel and customer service.
  These pharmacy issues include formulary drug coverage, appeal and
  reconsideration claim status, and pricing for drug claims.
• Completes daily formulary operational processes, including tracking,
  processing, and obtaining appropriate documentation for pharmacy
  medical exception requests, prior authorization requests,
  reconsiderations, and appeals.
• Prepares reconsideration requests for Clinical Pharmacy Consultant
  review by obtaining and organizing appropriate documentation,
  including, but not limited to medical chart notes/reports and
  medication profiles.
• Communicates (orally and by written documentation) information and
  determinations to providers and members as necessary.
• Obtains and organizes drug utilization data, including patient
  specific and population-based data, in a manner which facilitates
  clinical review and decisions by Clinical Pharmacist Consultants.
  Organizing data includes but is not limited to sorting drugs into
  appropriate therapeutic and generic categories.
• Assists with auditing and investigations of medication-related
  claims, cases, and providers to identify misuse of medications,
  misuse of (Regence HMO Oregon) resources, substance abuse, and
  erroneous and fraudulent billing practices.
• Investigates and organizes workflow for claims referred to Pharmacy
  Services for review and allowable determination (misc. J codes,
  providers on review, reconsiderations).
• Supports wellness and disease state management programs for Pharmacy
  Service and corporately which contribute to NCQA accreditation and
  ongoing quality improvement.
• Contributes to and supports the corporation’s quality initiatives
  through process improvement teams and by encouraging team and
  individual contributions toward the corporation’s quality
  improvement efforts.

Minimum Requirements

• Knowledge of Medical terminology, health care coding systems such as
  ICD 10, CPT and HCPCS and HIPPA regulations.
• Knowledge of Pharmaceutical products, including orals, injectables,
  infusion products, and chemotherapy.
• Knowledge of general office practices and procedures.
• Demonstrated knowledge of Grammar and techniques of business
  practice.
• Ability to interact effectively with a variety of health care
  professionals, including physicians, nurses, pharmacists, and
  billing staff both internally and externally.
• Demonstrate maturity, tact, diplomacy, and persuasiveness.
• Demonstrated ability to perform pharmaceutical pricing calculations.
• Ability to type 30 words per minute, 60 wpm preferred.
• Demonstrated ability to operate a variet of standard business
  machines including calculators, copiers, and faxes.
• Basic computer programs skills (Word, Excel, etc.).
• Ability to organize, plan, and prioritize daily workflow and
  projects within time constraints.
• Experience with health insurance and/or prescription benefits
  preferred.

Normally to be proficient in the competencies listed above

Pharmacy Services Technician would have a high school diploma or related
certificate and five years of experience as a pharmacy services
technician in a retail, hospital, or other licensed pharmacy setting or
equivalent combination of education and experience. Pharm tech
certificate may be substituted for two years of experience.

Work Environment

• Work primarily performed in an in-home environment.
• May be required to work overtime.

The hourly range for this role is $16.25 – $30.50.

The bonus target for this position is 5%.

Base pay is just part of the compensation package at Cambia that is
supplemented with an exceptional 401(k) match, bonus opportunity and
other benefits. In keeping with our Cause and vision, we offer
comprehensive well-being programs and benefits, which we periodically
update to stay current.