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Pharmacy Tech I/II (Prior Auth...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Saint Louis, MO
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_139309

Pharmacy Tech I/II (Prior Authorization) 139309

About the Job

Description

Anthem, Inc. is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.

The Pharmacy Tech I is responsible for the interpretation and data entry of basic prescriptions, prior authorization processing, and troubleshooting adjudication issues.

Primary duties may include, but not limited to:

  • Verifies member information and inputs data for the pharmacists.

  • Processes prior authorization requests from physicians' offices and ensures compliance with all Medicare, regulatory and accreditation requirements; informs relevant parties of all prior authorization determinations.

  • Provides resolution to grievances and appeals issues.

  • Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.

  • Enters and maintains accurate prior authorization records

  • Document accurate outreach to members and providers

  • Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations.

  • Refers cases requiring clinical review to a Pharmacist or Medical Director.

  • Responsible for the identification and data entry of pharmacy prior authorization requests.

  • Conducts clinical screening process.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

The Pharmacy Tech II is responsible for educating members on medication as related to prescriptions; advising members of available resources and assistance programs; interpreting moderately complex prescriptions.

Primary duties may include, but are not limited to:

  • Processes prior authorization requests from physicians' offices and ensures compliance with all Medicare, regulatory and accreditation requirements; informs relevant parties of all prior authorization determinations.

  • Reviews member prescriptions in claims history.

  • Document accurate outreach to members and providers

  • Verifies member information and inputs data for the pharmacists.

  • Provides resolution to grievances and appeals issues.

  • Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.

  • Enters and maintains accurate prior authorization records

  • Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations.

  • Refers cases requiring clinical review to a Pharmacist or Medical Director.

  • Responsible for the identification and data entry of pharmacy prior authorization requests.

  • Conducts clinical screening process.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

The Pharmacy Technician employs intellectual, interpersonal and technical skills through the utilization of the pharmacy process to assist members in achieving and maintaining maximum health potential.

Qualifications
Qualifications
  • Pharmacy Tech I requires a high school diploma; 1 year of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.
  • Current State Pharmacy Technician License and National Certification required.

  • Pharmacy Tech II requires a high school diploma; 2 years of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.
  • Current State Pharmacy Technician License and National Certification required.

This positions requires that you be available to work an 8 hour shift between 7am-9pm CST including weekends and holidays. It may also require mandatory over time at times.

  • Prior call center experience strongly preferred.
  • Medical terminology training, pharmaceutical terminology experience and/or experience in medical, insurance or pharmaceutical field are preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
 

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