Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview: Coordinate application of pharmacy services and benefits as an integral contributor on the pharmacy team. Handle pharmacy-related inquiries and communicate benefit determinations. Provide pharmacy services helpdesk support to pharmacies, providers, and members. Perform pharmacy authorization and claim processing services.
Act as principal contact regarding drug authorizations and system overrides. Help to resolve pharmacy services and benefits inquiries through skillful knowledge of the pharmacy claims, medical claims, and utilization management platforms.
Initiate clinical review and decision-making of authorization requests under the guidance of clinical pharmacists.
Effectively communicate and collaborate in a clear and concise manner to internal and external partners, including translating clinical and technical industry jargon to appropriate audiences.
Function as liaison with pharmacy benefit manager, pharmacies, physicians, and others in order to apply benefits, and assist with pharmacy benefit determinations.
Consult with clinical pharmacists and other staff in determining coverage for pharmacy-related services and pharmaceuticals.
Prepare and process member-submitted pharmacy claims in the pharmacy benefit manager's claims processing system.
Ensure all coverage determinations are processed in a timely and accurate manner, consistent with Commercial, Medicare & Medicaid regulatory requirements and department policies.
Serve as primary resource to members and providers for pharmacy questions related to the health plan and in navigating through the health systems.
Provide support and maintenance for department communication tools (ie. Sharepoint), as applicable.
Assist Pharmacy Services Leadership to ensure compliance with all rules and regulations as applicable.
Meet department and company performance and attendance expectations.
Perform other duties as assigned
Minimum two years Pharmacy Technician experience. Demonstrated ability to work efficiently and effectively with a high attention to detail.
Education, Certificates, Licenses: Minimum high school diploma. Unrestricted pharmacy technician license by the Board of Pharmacy and previously passed National Pharmacy Technician certification exam required. Maintain continuing education requirements for license renewal.
Knowledge: Good understanding of Medical Terminology required. Familiarity of CPT/ICD-10 codes, home infusion therapies, and specialty medications helpful. Microsoft Office products including Word, Excel, and Outlook.
Ability to work under time sensitive deadlines. Ability to prioritize responsibilities, diplomatically, handle demanding situations and manage workload with direct supervision. Demonstrate organizational and time management skills.
Ability to understand and interpret Federal and State specific regulatory requirements helpful. Ability to communicate effectively across all levels of the business on a consistent basis.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 1% of the time.
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.