Clinical Pharmacy Technician I

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Clinical Pharmacy Technician I
Summary
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

• Researches, resolves and documents prior authorization outcomes in pharmacy system.
• Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• For CPTs assigned to work the fax queue, responsibilities will also include:
• Performs other duties as required.
• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).
• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.
• Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.

Responsibilities

• Must have an active pharmacy technician licensure or registration in accordance with state requirements.
• If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
• Excellent written and verbal communication skills.
• In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
• Active Pharmacist license supersedes requirement for CPT and/or PTCB.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• Ability to identify and trouble-shoot problematic issues.
• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.

Work Experience
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education
Education - Required
GED, High School
Education - Preferred
Certifications
Certifications - Required
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy - Pharmacy
Certifications - Preferred
Potential pay for this position ranges from $15.29 - $22.93 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.