Quality Assurance Pharmacy Technician II

Elevance Health•Mason, OH

1d•Remote

About The Position

Quality Assurance Pharmacy Technician II Location: OH-Mason, 4241 Irwin Simpson Blvd Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health. The Quality Assurance Pharmacy Technician II is responsible for the interpretation and data entry of moderately complex prescriptions, intervention data criteria verification, and troubleshooting criteria issues.

Requirements

Requires an active, professional license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.
Requires H.S. diploma or equivalent and minimum of 2 years of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Experience in a high volume, strong attention to detail position.
Ability to communicate information clearly and concisely, both orally and in writing, in a professional environment.
Specialty Pharmacy experience.
PTCB Certification.
Pharmacy claim adjudication experience.

Responsibilities

Verifies member information and inputs data for the pharmacists.
Quality assurance reviews on clinical mailings.
Audit data criteria for mailing information.
Educates members on pharmacy based rules related to prescriptions and medication resources or assistance programs.
Processes prior authorization requests from physicians' offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations.
Provides resolution to grievances and appeals issues.
Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.
Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad-hoc reports.
Maintains record keeping of prior authorizations, rebates, and monthly reports.