Title: Pharmacy Technician (Call Center/Help Desk)
Location: Detroit, MI **Remote
Duration: 14 month contract with chance of extending or converting to full time.
Role Type: W2 Contract Engagement
Pay Rate: $20-$22/hour

SUMMARY

Department: Pharmacy Help Desk

Support providers (pharmacists and physicians) with Medicare Part D and/or Commercial pharmacy/ specialty drug benefits analysis, drug coverage inquiries and prior authorizations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

* 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.

EDUCATION AND/OR EXPERIENCE

* High School Graduate of GED equivalent required. Two (2) years of college preferred.
* Two (2) years experience in retail or hospital Pharmacy required.
* Pharmacy Technician Certification (PTCB) preferred.
* Knowledge of prescription drug names, therapeutic classes and claims processing.
* Experience with Medicare Part D prescription benefits may be preferred for some positions.

OTHER SKILLS AND ABILITIES

* Expert knowledge of pharmacy claims processing
* Understanding of formularies and utilization management edits
* Familiarity with pharmaceutical manufacturers and product/cost information
* Computer Literate (Microsoft Office Products).
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