at Prime Therapeutics in Springfield, Illinois, United States
Job Description
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
ADAP Call Center – Connecticut Clinical Pharmacy Technician – REMOTE
Job Description Summary
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Job Description
+ Seeking clinical pharmacy technician working remotely in Connecticut with active and in good standing national pharmacy technician certification and Connecticut Pharmacy Technician license/registration.
+ Will take inbound calls from member, providers, pharmacies and other healthcare professionals for current and potential ADAP member populations for client programs across organization.
+ Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
+ Researches, resolves and documents prior authorization outcomes in pharmacy system.
+ Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
+ Escalates requests to Pharmacist when request requires extensive clinical review or denial.
+ Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
+ Performs other duties as required.
+ For CPTs assigned to work the fax queue, responsibilities will also include:
+ Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.
+ Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).
Responsibilities
+ Must have an active pharmacy technician licensure or registration in accordance with state requirements.
+ If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
+ In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
+ Active Pharmacist license supersedes requirement for CPT and/or PTCB.
+ Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
+ In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
+ Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
+ Excellent written and verbal communication skills.
+ Ability to follow clinical criteria and instructions to approve prior authorization requests.
+ Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
+ Ability to identify and trouble-shoot problematic issues.
Work Experience
Work Experience – Required:
Pharmacy
Work Experience – Preferred:
Education
Education – Required:
GED, High School
Education – Preferred:
Certifications
Certifications – Required:
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements – Pharmacy – Pharmacy
Certifications – Preferred:
Potential pay for this position ranges from $15.29 – $22.93 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the “Benefits at a glance” button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.
Prime Therapeutics’ fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today’s health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people’s lives.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ? If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
