Remote Ncqa Accreditation Jobs (NOW HIRING)

Pharmacy Services Technician

Work from home Within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated Pharmacy Services Technician, are living our mission to make health care easier and lives better. As a member of the Pharmacy Operations team, our 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, all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• High school diploma or related certificate required

• Three years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting, or equivalent combination of education and experience

• Pharmacy Technician certificate may be substituted for two years of experience

Skills and Attributes:

• Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS, and HIPAA regulations, along with knowledge of pharmaceutical products including orals, injectables, infusion products, and chemotherapy

• Knowledge of general office practices and procedures with 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, while demonstrating maturity, tact, diplomacy, and persuasiveness

• Demonstrated ability to perform pharmaceutical dosing calculations and operate a variety of standard business machines including calculators and faxes

• Ability to type 30 words per minute (60 wpm preferred) with basic computer program skills including Word, Excel, and other standard applications

• Ability to organize, plan, and prioritize daily workflow and projects within time constraints; experience with health insurance and/or prescription benefits preferred

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Perform all duties as described unless clinical judgment is required, in which case seek assistance from appropriate medical personnel who will be available for support during normal business hours

• Respond to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, government programs personnel, and customer service regarding formulary drug coverage, appeal and reconsideration claim status

• Complete daily formulary operational processes including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals

• Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation including medical chart notes, reports, and medication profiles; communicate information and determinations to providers and members orally and through written documentation as necessary

• Obtain and organize drug utilization data including patient-specific and population-based data in a manner that facilitates clinical review and decisions by Clinical Pharmacist Consultants, including sorting drugs into appropriate therapeutic and generic categories

• Assist with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices; investigate and organize workflow for claims referred to Pharmacy Services for review and allowable determination including miscellaneous J codes, providers on review, and reconsiderations

• Support wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement; contribute to and support the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts

#LI - Remote

The expected hiring range for a Pharmacy Services Technician is $20.50 - $30.80 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 5%. The current full hourly range for this role is $19.20 - $34.90 an hour.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.