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
Call Center Clinical Pharmacy Technician – Starting at $19.50/hr – 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
Position Requirements:
+ Must have dedicated, secure high-speed cable, DSL, or fiber internet (i.e., Earthlink, CenturyLink or Frontier). No wireless or 5G home internet connections (including T-Mobile, Verizon, community Wi-Fi or “hotspots”)
+ 100% inbound call center remote position
+ Must be able to work a schedule that could include evenings, weekends, holidays, and mandatory overtime based on business needs
+ Must have the ability to adhere to a pre-determined schedule, including planned rest & meal breaks.
+ Must have dedicated home workspace that would be private, quiet, without interruption and minimal distractions during your scheduled work shifts – including a door that can be physically secured
+ Must be available for a 6 to 8 week training class
What Prime provides:
+ All equipment is provided and shipped directly to your place of residence
+ Highly structured work environment
+ Transferable skills within Prime or within the healthcare field
+ Opportunities to grow your career within Prime
+ Medical, dental, and vision insurance, paid time off, 401k match, and more
+ 40-hour work week (potential overtime)
Job Responsibilities:
+ As a Call Center Clinical Pharmacy Technician working remotely, you will be responsible for high volume inbound call center serving calls from Members, Pharmacies and Prescribers for Medicaid/Medicare or commercial pharmacy benefits management business.
+ You will be evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
+ Your performance measurements include quality, average handle time, productivity metrics, schedule adherence, and behavioral competencies.
+ You must be available to work a set schedule during training and must be available and commit to work any assigned shift between the hours of 8AM and 10PM EST daily including weekends and holidays.
+ You will determine appropriateness for medications and communicate decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
+ You will research, resolve and document prior authorization outcomes in pharmacy system.
+ You will communicate selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
+ You will escalate requests to Pharmacist when request requires extensive clinical review or denial.
+ You will research, resolve and document physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
+ You will perform 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).
Minimum Qualifications:
+ High School Diploma or GED is required
+ 2 years of Pharmacy experience
+ An active and good standing pharmacy technician license/registration in accordance with the state requirements you live in
+ 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)
+ Must be eligible to work in the United States without need for work visa or residency sponsorship
Preferred Qualifications:
+ Work from home (remote) experience
+ Previous Inbound Call Center experience
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, or that restrict licensure to employees of dispensing pharmacies, 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:
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.
Positions will be posted for a minimum of five consecutive workdays.
