CPhT Pharmacy Technician - Managed Care
Boston, MA (near Cambridge)
***Must be a Certified Pharmacy Technician (CPhT) with prior experience at a Health Plan***
CPhT Pharmacy Technician Summary:
CPhT Pharmacy Technician Profile:
- The Pharmacy Technician is primarily responsible for assisting in administering and maintaining Medicare pharmacy programs in compliance with Medicare Part D guidelines.
- Using established guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits.
- They examine health insurance claims to assess whether the provider or the claim holder must pay for medical services that the claim holder received.
- They respond to issues and questions regarding the prior authorization of claims and the formulary process. Preforms review of processing claims to assess validity and determine financial responsibility for medical services that the member received.
- They assist with the education of internal staff and contracted providers on pharmacy related Medicare Part D topics.
- Duties include communicating with members and providers by phone and responding accordingly to concerns, adjusting and or referring complaints to appropriate departments, and investigating issues to find proper solutions.
- Review, research, code and enter claims through several computer systems; enter patient grants for payment; import and reconcile data from electronic invoice transmissions.
- Must have certification as a Certified Pharmacy Technician (CPhT) from Pharmacy Technician Certification Board (PTCB).
- Around 2-3 years of Pharmacy Technician experience required, preferably in a managed care environment.
- Requires at least 1 year experience working at a Managed Care Organization / Health Plan.
- Must have experience handling prescription claims through Medicare Part D.
- Familiarity with Formulary Lists including common edits and restrictions.
- Experience working with Quality Improvement Initiatives and STAR Ratings is highly desirable.
- Must possess a solid understanding of pharmacy claims from the health insurance perspective.
- Demonstrated superior verbal communication skills by telephone.
- Excellent, clear speaking voice and solid command of the language.
- Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
- Functions well in an environment that requires incumbent to be a self-starter.