Clinical and Technical Call Center Pharmacy Technician Remote Position - Should be in Central or Eastern Time Zone Summary: The Pharmacy Technician for the PBM clinical and technical call center is expected to be a subject matter expert in areas of pharmacy knowledge as well as call center operations. Duties will include, but are not limited to, answering incoming calls and making outgoing calls for members, medical providers, or pharmacy providers, appropriate processing of prior authorization requests, and assisting members and providers with inquiries through other media platforms (fax, web, e-mail)
Responsibilities: - Remain compliant with all PHI protocols and requirements including the handling of company confidential data according to policy and guidelines. Adheres to existing security policies and procedures.
- Process submitted prior authorization requests within the required time frame mandated by the State client
- Completion of approval process for prior authorizations where all criteria is met and clinical judgment of a pharmacist is not required
- Complete necessary communication with providers regarding status of their authorization submission or any other inquiries
- Follow standard operating procedures to receive incoming calls and use learned knowledge and resources to resolve the call on initial contact
- Provide a positive experience when communicating with members and providers
- Complete outreach to providers to obtain information when required
- Appropriately document all inquiries received via phone, fax, or email for members or providers
- Provide a high level of customer care with our members and providers
- Meet all department requirements, goals, and performance expectations
- Complete all tasks assigned within regulatory guidelines
- Actively identify areas of inefficiencies and provide innovative suggestions to leadership to keep processes current
- Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements.
- Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area.
- Demonstrates knowledge and skill in assigned work processes.
- Complete any additional job-related tasks as requested
Skills: - Strong verbal and written communication skills
- Balance's accuracy, quality, and efficiency in all tasks
- A willingness and ability to learn internal systems/processes/programs, as needed
- Basic math skills
- Familiarity with medication names and medical terminology
- General computer knowledge including Microsoft Office, use of the internet, and email is required
- Ability to learn quickly, solve problems, and make decisions with minimal supervision
- Ability to adapt and work collaboratively in a fast-paced, production environment
- Willingness to work a flexible schedule to accommodate peak volume times
- Excellent attention to detail
- Effective communication skills with internal and external clients, verbally and written
- Knowledge of pharmacy insurance claims
- Organization skills to balance and prioritize work
- Ability to multi-task
- Ability to work independently and as part of a team
Requirements: - Must be at least 18 years of age
- High school diploma or GED required
- Active certified pharmacy technician from accredited program (PTCB, ExCPT, etc.)
- 2 years of relevant experience as a pharmacy technician in retail pharmacy, hospital pharmacy, managed care, insurance, or pharmacy benefit management
About Diversified Systems Founded in 1990, Diversified Systems is an award-winning Technology Services corporation providing all levels of IT project consulting services nationwide. DSI is headquartered in Columbus, Ohio with regional offices in the American Midwest and East Coast. We offer our consultants a number of flexible and competitive compensation benefit packages.
Diversified Systems is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations.
Diversity, Equity and Inclusion
DSI values authenticity and is committed to making sure our employees and partners are valued and respected. At DSI, we believe building a diverse culture is important because we know when people work together, we can achieve better results as a team. DSI realizes that everyone comes from various backgrounds. We celebrate these differences because our employees are our greatest asset as we strive to best meet the needs of those we serve. As part of our ongoing efforts, DSI is focused on advancing equality, diversity, and inclusion by setting high standards to continually evolve our culture. This includes but is not limited to recruiting, community involvement, client delivery, and career development.
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Last updated on Jun 20, 2023