AmeriHealth Caritas Pharmacy Services Technicians in Philadelphia, Pennsylvania
Pharmacy Services Technicians
Location: Philadelphia, PA
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
The Pharmacy Services Technician is responsible for the data entry process for prior authorization requests. This includes transferring data from a prior authorization form into the demographic fields of our application, making outreach calls to obtain missing information, checking the eligibility system to identify third party coverage, completing questions to approve prior authorization requests or send to the pharmacist, and working from an Excel spreadsheet to identify opioid drugs.
Reviews and approves physician inquiries for pre-authorization, appeal and medical necessity requests based on established pharmacy guidelines and contract criteria
Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered, and recommends course of action for Providers where patterns appears outside of guidelines and generally accepted pharmacy standards
Maintains and updates internal databases. Enters prior authorizations and other relevant data. Ensures database information and appended files are current and accessible to staff. Generates reports and other information requested on a scheduled/as needed basis.
Supports internal staff with assisting plan members in understanding and better utilizing their pharmacy benefits
Creates and supports an environment which fosters teamwork, cooperation, respect and diversity
Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times
Performs other related duties as assigned
Attends required training on an annual basis
Adheres to company’s policies and procedures
High School Diploma or equivalent required
Associate’s degree preferred
Current PTCB or NCCT certificate required
Prefer a minimum of one (1) year of current/recent PBM, managed care, hospital pharmacy, LTC pharmacy, Home Infusion pharmacy, retail pharmacy experience
Minimum 35 words per minute typing speed
EOE Minorities/Females/Protected Veterans/Disabled