Pharmacy Technician

OVERVIEW:
TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.
JOB DESCRIPTION
Support Clientproviders (pharmacists and physicians) with Commercial pharmacy/ specialty drug benefits analysis, drug coverage inquiries and prior authorization
ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE THE FOLLOWING. OTHER DUTIES MAY BE ASSIGNED.
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Answer telephones in an efficient and timely manner to lend appropriate assistance to providers
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Triage prior authorization requests under the supervision of a Clinical Pharmacist.
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Assists in maintaining pharmacy prior authorization criteria used in the adjudication of pharmacy/specialty claims.
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Analyzing written inquiries which lends to entry and updating of pharmacy authorizations into the claims system.
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Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool.
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Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.
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Assist with internal control systems and regulations compliance.
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Perform other related duties as assigned.
TOP 3 REQUIRED SKILLS/EXPERIENCE
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2 years retail pharmacy experience
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Knowledge of adjudicating pharmacy claims
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Computer Literate (Microsoft Office Products)
REQUIRED SKILLS/EXPERIENCE THE REST OF THE REQUIRED SKILLS/EXPERIENCE. INCLUDE:
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Two (2) years experience in retail Pharmacy required.
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Knowledge of prescription drug names, therapeutic classes and claims processing
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Expert knowledge of pharmacy claims processing
TEKWISSEN GROUP IS AN EQUAL OPPORTUNITY EMPLOYER SUPPORTING WORKFORCE DIVERSITY.