- Support Client providers (pharmacists and physicians) with Commercial pharmacy/ specialty drug benefits analysis, drug coverage inquiries and prior authorization
- Answer telephones in an efficient and timely manner to lend appropriate assistance to providers
- Triage prior authorization requests under the supervision of a Clinical Pharmacist.
- Assists in maintaining pharmacy prior authorization criteria used in the adjudication of pharmacy/specialty claims.
- Analyzing written inquiries which lends to entry and updating of pharmacy authorizations into the claims system.
- Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool.
- Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.
- Assist with internal control systems and regulations compliance.
- Perform other related duties as assigned.
- 2 years retail pharmacy experience
- Knowledge of adjudicating pharmacy claims
- Computer Literate (Microsoft Office Products)
- Two (2) years experience in retail Pharmacy required.
- Knowledge of prescription drug names, therapeutic classes and claims processing
- Expert knowledge of pharmacy claims processing
- High School Graduate of GED equivalent required. Two (2) years of college preferred
- Pharmacy Technician Certification (PTCB) preferred
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Pharmacy Technician - Detroit, United States - Tekwissen
Description
Overview:TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.
Title: Pharmacy Technician
Work Location: Detroit MI 48243
Duration: 5 Months
Job Type: Contract
Work Type: Onsite
Dept: Pharmacy Help Desk Comm
Job Description
Engagement Description
Education/Certifications - Include: