"We are in urgent need of PHARMACY TECHNICIAN for a well-known being the largest Medicaid Managed Care Organization in the country, also the largest carrier in the Health Insurance Marketplace and a national leader in managing long-term services and support"
Facility: Health Insurance
Location: Tempe, AZ 85281
Pay: 18.50/hour (Weekly pay)
Hours: Mon-Fri 8am-5pm (Full Time)
Arizona State Pharm Tech License
National Pharm Tech Certificate (PTCB Certification)
Pharmacy Tech Experience
High school Diploma
Day to day
- Formulary Management:
- Reviews and processes formulary change requests from Health Insurance plans
- Submits and maintains formulary change requests to Health Net’s pharmacy claims processor
- Generates, maintains and reviews Formulary Status Grids
- Uses reports to perform audits and quality checks on the current formulary status for accuracy and contract compliance
- Assists Clinical Pharmacist with formulary database maintenance and updates to company web site
- Pharmacy Audit and Recovery:
- Performs a variety of assignments required for pharmacy audit and recovery functions.
- Reviews paid claims for quantity and/or billing discrepancies. Corresponds with pharmacies as needed to communicate review finding.
- Faxes inquiries to pharmacies related to review findings
- Answers in-coming calls and responds appropriately to faxed correspondence from pharmacies
- Updates Access database with incoming phone calls, faxes and e-mails
- Pharmacy Services Center:
- Takes member inquiry calls for benefit questions including prior authorization requests
- Maintains expert knowledge on all Health Net Medicare Pharmacy benefits and formularies, including CMS regulations as they pertain to this position.
- Educates the member on their specific pharmacy benefit and offers them options including the submission of a prior authorization request.
- Process member submitted claims.
- Prior Authorization:
- Reviews requests made by physicians and pharmacies for use of prescription drugs that are non-formulary, have prior authorization requirements, have exceeded quantity or cost limits, or require assistance in on-line processing of a prescription claim.
- Assign, enter and document prior authorizations into appropriate claims processing system.
- Answer phone calls for prior authorization inquiries
- Researches and resolves issues using the appropriate reference material.