Pharmacy Technician II

PacificSource Health Plans•Bend, OR

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Coordinate application of pharmacy services and benefits as an integral contributor on the pharmacy team. Handle pharmacy-related inquiries and communicate benefit determinations. Provide pharmacy services helpdesk support to pharmacies, providers, and members. Perform pharmacy authorization and claim processing services.

Requirements

Minimum two years Pharmacy Technician experience.
Demonstrated ability to work efficiently and effectively with a high attention to detail.
Minimum high school diploma or equivalent.
Unrestricted pharmacy technician license by the Board of Pharmacy and previously passed National Pharmacy Technician certification exam required.
Maintain continuing education requirements for license renewal.
Good understanding of Medical Terminology required.
Microsoft Office products including Word, Excel, and Outlook.
Ability to work under time sensitive deadlines.
Ability to prioritize responsibilities, diplomatically, handle demanding situations and manage workload with direct supervision.
Demonstrate organizational and time management skills.
Ability to communicate effectively across all levels of the business on a consistent basis.

Nice To Haves

Familiarity of CPT/ICD-10 codes, home infusion therapies, and specialty medications helpful.
Ability to understand and interpret Federal and State specific regulatory requirements helpful.

Responsibilities

Act as principal contact regarding drug authorizations and system overrides.
Help to resolve pharmacy services and benefits inquiries through skillful knowledge of the pharmacy claims, medical claims, and utilization management platforms.
Initiate clinical review and decision-making of authorization requests under the guidance of clinical pharmacists.
Effectively communicate and collaborate in a clear and concise manner to internal and external partners, including translating clinical and technical industry jargon to appropriate audiences.
Function as liaison with pharmacy benefit manager, pharmacies, physicians, and others in order to apply benefits, and assist with pharmacy benefit determinations.
Consult with clinical pharmacists and other staff in determining coverage for pharmacy-related services and pharmaceuticals.
Prepare and process member-submitted pharmacy claims in the pharmacy benefit manager’s claims processing system.
Ensure all coverage determinations are processed in a timely and accurate manner, consistent with Commercial, Medicare & Medicaid regulatory requirements and department policies.
Serve as primary resource to members and providers for pharmacy questions related to the health plan and in navigating through the health systems.
Provide support and maintenance for department communication tools (ie. Sharepoint), as applicable.
Assist Pharmacy Services Leadership to ensure compliance with all rules and regulations as applicable.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned