Job Description: 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. Handle pharmacy-related inquiries and communicate benefit determination. Act as a liaison and information resource to internal and external pharmacy services customers. Provide pharmacy services Help-Desk support. Provide pharmacy claims processing services. Conduct claims audits and prepare prior authorization statistics.
Act as principal contact regarding drug pre-authorizations and system overrides.
Help to resolve issues related to pharmacy services.
Provide customer service for all pharmacy-related calls.
Collect appropriate clinical and benefit information.
Relate determination decisions.
Function as liaison with pharmacy benefit management company, pharmacies, physicians, and others in order to apply benefits, and assist with pharmacy benefits determinations.
Research new pharmaceuticals and indications to help determine clinical appropriateness, cost, coverage, and copayments.
Consult with Clinical Pharmacists and other professional staff in determining coverage for pharmacy-related services and pharmaceuticals.
Prepare and process member-submitted pharmacy claims in the pharmacy benefit managers claims processing system.
Ensure all coverage determinations are processed in a timely and accurate manner, consistent with Commercial, Medicare & Medicaid oversight and department policies.
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.
Minimum six months Pharmacy Technician, Pharmacy Assistant, or equivalent experience.
One year of customer service or health insurance experience desirable.
Education, Certificates, Licenses: Minimum high school diploma. Certification as a pharmacy technician through the Pharmacy Technician Certification is required upon hire or within 6 months after hire.
Knowledge: Medical terminology. Microsoft Office products including Word, Excel, and Outlook.
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 0% 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 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.