Pharmacy Service Coord PCHP

1 month ago

Dallas, United States Parkland Health and Hospital System (PHHS) Full time

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion. Primary Purpose Parkland Community Health Plan's (PCHP's) Pharmacy Services Coordinator performs both clinical and non-clinical tasks to provide support to both internal and external clients and other departments. This role will ensure prompt processing of requests to meet turnaround time and other required deliverables and prerequisites. Minimum Specifications Education Must have a High School diploma or equivalent. Prefer some college courses. Prefer completion of ACPE or ASHP accredited pharmacy technician training program. Experience At least 3 years of experience as a Pharmacy Technician. At least 1 year of experience in a managed care organization. Experience with a Pharmacy Benefit Manager or call center is desired. Experience in prior pharmacy technician health system roles such as inpatient pharmacy, IV/Infusion pharmacy, retail pharmacy, and/or mail order pharmacy is desired. Equivalent Education and/or Experience A bachelor's degree in a science related field may substitute for 3 years of experience as a pharmacy technician. Certification/Registration/Licensure Must hold a current Certified Pharmacy Technician (CPhT) certification by exam from the National Pharmacy Technician Certification Board (PTCE) or the National Healthcare Association (ExCPT). Must have current registration with the Texas State Board of Pharmacy. Required Tests for Placement Skills or Special Abilities Excellent customer service and phone etiquette skills. Attention to detail with focused accuracy. Basic knowledge of Microsoft Office, internet and typing skills. Energetic self-starter who can work independently as well as in a team. Excellent time management skills with the ability to structure and prioritize work in a manner that best fits team needs. Ability to manage multiple projects while maintaining deliverables and timelines. Proficient in pharmacy calculations. Knowledge of and ability to search InterQual screening criteria as well as DRG, ICD-10 and CPT coding is recommended, but not required. Responsibilities Assists pharmacists in meeting the pharmaceutical needs of our members and serve as liaison between pharmacists and medication management systems. Provides both clinical and nonclinical information relevant to assist members, physicians, pharmacists, and internal staff with pharmacy services including, but not limited to; pharmacy benefits and claims processing. Such as eligibility verification, non-formulary overrides, claims adjudication and reimbursement requests in accordance with member's benefit plan. Tracks and evaluates pharmacy requests to ensure drug utilization and member documentation meet regulatory standards with accurate service area designation. Acknowledges member and healthcare provider inquiries and refers to the Pharmacist for assistance and completion. Receives prior authorizations and prepare resolution(s) to be reviewed by pharmacist and pharmacy/medical director for a decision. Maintains compliance with all federal and state laws, rules and regulations of Centers for Medicare and Medicaid Services (CMS), various state board of pharmacies, PCHP, and prescription drug plans. Monitor and report any fraud, waste and abuse activity. Other duties as assigned. Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus. #J-18808-Ljbffr

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