Pharmacy Benefit Technician

Sanford Health•Sioux Falls, SD

3d•Onsite

About The Position

This job involves a significant amount of time on the telephone handling calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale. Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member (depending on where the request originates) to clarify the intent of the prior authorization and identify any potential missing information. Enter prior authorizations and formulary exception requests into referral form. Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review. Will complete initial and benefit denial letters. Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise. Serve as a resource for other departments within the health plan. Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.

Requirements

High school diploma or equivalent.
Familiarity with computers and ability to work with multiple programs at the same time.
Excellent oral and auditory skills for productive interoffice dialogue and Member or provider interactions.
Nationally certified (CPhT designation), either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA).
Registration with the South Dakota Board of Pharmacy required within 30 days from the date of hire (if applicable based on hire date and previous registration status).

Nice To Haves

Experience with inpatient and retail pharmacy utilization.
Broad knowledge of pharmacy practice.

Responsibilities

Handle calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale.
Review incoming prior authorization requests and contact relevant parties to clarify intent and identify missing information.
Enter prior authorizations and formulary exception requests into referral forms.
Review Plan policy to determine which requests need to be sent to the clinical pharmacist team.
Complete initial and benefit denial letters.
Serve as a liaison with the pharmacy benefit manager (PBM) regarding pharmaceutical questions or issues.
Serve as a resource for other departments within the health plan.
Meet and maintain all benchmark statistics including prior authorizations, medical claims reviews, phone, approval, denial letters, and CRM volume.