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Pharmacy Services Technician - Remote
Pharmacy Services Technician - RemoteLocation :Philadelphia, PA Primary Job Function :Pharmacy ID27899Job BriefActive / current National Pharmacy Technician Certification (ExCPT, NCCT or PTCB) required.Your career starts now.We're looking for the next generation of health care leaders.At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities.As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs.AmeriHealth Caritas is seeking talented, passionate individuals to join our team.Together we can build healthier communities.If you want to make a difference, we'd like to hear from you.Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience.We deliver comprehensive, outcomes-driven care to those who need it most.We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.Discover more about us at the general supervision of the Supervisor of Pharmacy Management, the Pharmacy Services Technician coordinates the daily responsibilities of the pharmacy benefit at the Health Plan level for all Health Insurance Marketplace lines of business in support of the AmeriHealth Caritas Next Director.OPEN TO CANDIDATES NATIONWIDEResponsibilities :Support day-to-day pharmacy Plan maintenance, which includes but is not limited to the following :assist other clinical associates with questions about pharmacy claims Support standard and ad-hoc reporting requests to tightly manage the utilization and cost of the Plan, to include any urgent requests that could be received internally from management or externally from the State Research benefit and claims related inquiries from external and internal stakeholders Assist in the research and resolution of pharmacy issues, and oversee all aspects of the approval and authorization process for drugs and covered medical supplies Assist with Member and Provider communications regarding Medical Pharmacy benefit changes, performing NCQA audits, and coordinate authorizations with the Appeals Team Manage the pharmacy appeals reconsiderations process Provide support to the Marketing and Customer Service staff, enabling them to assist members in understanding and utilizing pharmacy benefits Support Fraud and Abuse program system oversight by reviewing medication utilization records; communicate any suspected fraud discovered.Recommend course of action for Providers where patterns appear outside of guidelines and generally accepted pharmacy standards.Keep abreast of industry trends and regulatory changes in the pharmacy industry and incorporate knowledge in the performance of job duties.Identify problems in process / procedures or services and makes recommendations for improvements.Maintain a balance of productivity, quality and timeliness of job accountabilities.Participate in department self-audit procedures for on-going evaluation of service.Maintain and update internal databases.Enter application information, prior authorizations and other relevant data.Ensure database information and appended files are current and accessible to staff.Generate reports and other information requested on a scheduled / as needed basis.Create and support an environment which fosters teamwork, cooperation, respect and diversity Establish and maintain positive communication and professional demeanor with internal and external business partners at all times Perform other related duties as assigned Attend required training on an annual basis Adhere to AMFC policies and procedureEducation / Experience :High School Diploma or equivalentrequiredActive / current National Pharmacy Technician Certification (NHA or PTCB)requiredCurrent / recent Pharmacy Benefit Manager (PBM), managed care, hospital pharmacy, long-term care (LTC) pharmacy, home infusion pharmacy, and / or retail pharmacy experience preferred +Requires :Working knowledge of Windows-based environment including Excel Strong communication (listening, verbal and written), customer service and interpersonal skills Demonstrated courteous and professional behavior Ability to multi-task and prioritize work Ability to comprehend and follow established office routines, policies and procedures Ability to adjust based on business / department needs EOE Minorities / Females / Protected Veterans / Disabled.
