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Job Summary:
The Pharmacy Technician II is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department.
Essential Functions:
Review traditional and specialty medication prior authorization requests for the member’s pharmacy benefit submitted by providers
Send fax communications to providers when necessary
Contact provider offices to follow up on failed faxes
Educate CareSource providers about resources outlining formulary alternatives
Place prior authorizations for when approval is appropriate in the prior authorization system(s)
Initiate process for routing prior authorizations requiring review by a pharmacist
Answer calls from providers regarding prior authorization requests prescription coverage and formulary issues in a timely manner
Perform outbound calls to obtain information from providers and/or pharmacies
Document all telephonic interaction in appropriate system(s)
Ensure all methods of inquiries (fax, e-mail, ePA) and submissions are answered with in the state mandated period
Involvement in special projects reviewed by the management team when needed
Answer calls and troubleshoot issues from retail and specialty pharmacies
Assist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questions
Maintain awareness of current workload aging and respond with appropriate sense of urgency
Maintain knowledge and understanding of all processes and procedures for all markets on faxes and phones
Adhere to all departmental and company policies and procedures
Perform any other job duties as requested
Education and Experience:
High School Diploma or equivalent years relevant work experience is required
Three (3) years retail pharmacy or hospital pharmacy experience is preferred
One (1) year managed care prior authorization experience is preferred
Competencies, Knowledge and Skills:
Computer proficient with knowledge in a “Windows” environment
Beginners level Microsoft Word, Outlook, and Excel
Must type 40 words per minute (WPM)
Professional level telephone communication skills
Familiarity with medical terminology
Familiarity with medication names
Excellent communication skills when speaking to providers offices, as well as pharmacies
Ability to work independently and within a team environment
Ability to train/teach new employees within the department
Attention to detail
Familiarity of the healthcare field
Knowledge of Medicaid/Marketplace
Critical listening and thinking skills
Proper grammar usage
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving
Leadership experience and skills
Licensure and Certification:
Pharmacy Technician Certification is preferred
Ability to acquire state registration in multiple states, as required
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Position requires the ability to work any shift between 7am and 9pm and the flexibility to work weekends and overtime, as needed
Compensation Range:
$35,900.00 - $57,300.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.