Pharmacy Technician

6 days ago

New York, New York, United States MetroPlus Health Plan Full time
Job Summary

MetroPlus Health Plan is seeking a highly skilled Pharmacy Technician to join our team in a key role that will play a critical part in ensuring the accuracy and integrity of our pharmacy benefit configuration. As a Pharmacy Technician - Operations, you will be responsible for auditing and validating internal and external reports to ensure proper benefit configuration, processing prior authorization requests related to the Medicare Lines of Businesses, and assisting in all other Pharmacy department directives.

Key Responsibilities
  • Data entry and processing of Medicare prior authorization requests, including inputting and providing notification to members and providers as appropriate.
  • Reviews daily claims reports of varying focuses across all lines of business to identify and report on the accuracy of the pharmacy benefit configuration.
  • Reviews daily rejection reports to identify and report on inconsistencies or concerns that may impact patient care.
  • Validates improper coding through verification between POS and UM platform systems.
  • Reviews daily reports to ensure all overrides are inputted correctly and claim adjudication is as intended.
  • Reaches out to members, pharmacies, and prescribers to reconcile benefit inconsistencies.
  • Reviews external communications for accuracy and appropriateness.
  • Assists with coordinating care between members, pharmacies, and providers to improve patient adherence for chronic medications and to promote other pharmacy initiatives, including assisting with pharmacy case management activities as needed.
  • Assists in preparing documentation for internal and external audits and regulatory submissions as needed.
Requirements
  • Associate degree with 4 years' experience as a Pharmacy Technician required.
  • Pharmacy experience in a managed care environment preferred.
  • Experience in auditing preferred.
  • Experience in government programs (Medicare, Medicare Part D, and Medicaid) preferred.
  • Proficiency with MS Word, Excel, and PowerPoint is required.
  • Proficiency with MS Access is preferred.
  • PTCB or ExCPT Pharmacy Technician Certification required.

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