Pharmacy Benefit Technician

Sanford Health

1d • $18 - $29

About The Position

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Responsible for following policies and procedures set within the pharmacy department to ensure that Members obtain appropriate medications in a timely, cost-effective, and efficient manner. Requires use of and proficiency in multiple computer programs. This job involves a significant amount of time on the telephone handling calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale. Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member (depending on where the request originates) to clarify the intent of the prior authorization and identify any potential missing information. Enter prior authorizations and formulary exception requests into referral form. Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review. Will complete initial and benefit denial letters. Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise. Serve as a resource for other departments within the health plan. Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.

Requirements

• Pharmacy technicians must have a minimum of a high school diploma or equivalent.
• Familiarity with computers and ability to work with multiple programs at the same time is required.
• The ability to work with multiple software programs concurrently allows a Pharmacy Benefits Technician to deliver the most accurate information to the Member or provider in a timely fashion.
• Must have excellent oral and auditory skills for productive interoffice dialogue and Member or provider interactions.
• Must be nationally certified (CPhT designation), either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA).
• South Dakota: Registration required within 30 days from the date of hire.
• Technicians registered with South Dakota Board of Pharmacy after July 1, 2014 will be registered as a “technician-in-training” and will have two years to complete training education and national certification through the Pharmacy Technician Certification Board (PTCB). Failure to obtain National Certification within two years of registering as a “technician-in-training” will result in termination of position.
• Technicians registered with the South Dakota Board of Pharmacy after July 1, 2011 will be required to obtain National Certification through the Pharmacy Technician Certification Board by July 1, 2014. Failure to obtain National Certification will result in termination of position.
• Technicians registered with South Dakota Board of Pharmacy before July 1, 2011 will be grandfathered in and not require national certification through Pharmacy Technician Certification Board.

Nice To Haves

• Experience with inpatient and retail pharmacy utilization, as well as a broad knowledge of pharmacy practice is preferred, but not required.

Responsibilities

• Handling calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale.
• Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member (depending on where the request originates) to clarify the intent of the prior authorization and identify any potential missing information.
• Enter prior authorizations and formulary exception requests into referral form.
• Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review.
• Complete initial and benefit denial letters.
• Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise.
• Serve as a resource for other departments within the health plan.
• Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees