Central Health

Pharmacy Technician- Medication Refill Specialist

Req No.
2022-6191
Company
CommUnityCare Health Centers
Name
Kramer
Address
2115 Kramer Lane, Suite 100
City
Austin
Category
Technicians
State
TX
Type
Regular Full-Time
Shift Days
Monday through Friday
Shift Hours
8:00 am to 5:00 pm

Overview

The Pharmacy Technician – Medication Refill Specialist is responsible for assisting patients in processing/submitting medication refills and insurance prior authorizations through the patient’s electronic health record.

Responsibilities

Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):


• Analyze and conduct investigation on paper medication refill faxes and the unmatched refill queue in patient electronic health records.
• Submit the refill requests to the providers via the electronic health record.
• Stop medications in the patients’ medical record appropriately referring back to the Standard Delegation Order in place with Compliance 360.
• Collect/maintain excel data and reports given to supervisor for productivity measures.
• Initiate, assist and coordinate with the specialty provider teams on assistance with the Prior Authorizations/Non-Formulary Drug Requests for Commercial, Medicaid, Medicare D, MAP and Sliding Fee Scale medication claims.
• Serve as backup for the Patient Assistance Program staff.
• Serve as liaison between patients, clinic staff, eligibility staff and outsourced pharmacies.
• Work/Cross train in internal Class A and D pharmacy operations for the purposes of maintaining competencies in those respective environments.
• Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly professional manner at all times.
• Ensure all tasks provided and associated with patient care, patient administrative process and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedure and CommUnity Care Policies and Procedures.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Develop and maintain favorable internal relationships, partnerships with team members, including clinical managers, clinical support staff, providers and business office staff.
• Initiate, assist and coordinate with the specialty provider teams on assistance with the Prior Authorizations/Non-Formulary Drug Requests for Commercial, Medicaid, Medicare D, MAP and Sliding Fee Scale medication claims.
• Initiate, assist and coordinate with primary care provider teams on Prior Authorizations.
• Initiate and assist with Non-Formulary Drug Requests for MAP and Sliding Fee Scale medications.
• Educate and train PAP Service Technicians as necessary or instructed.
• Perform other duties as assigned.


Knowledge/Skills/Abilities:


• Possess the clinical knowledge required as a Pharmacy Technician to complete refill requests per the Standard Delegation Order with CommUnityCare.
• Possess critical thinking skills as well as the clinical knowledge required to seek further clarification from supervisor or provider when needed.
• Possess the ability to work independently to resolve complex/complicated problems using their best clinical judgment.
• Possess the clinical knowledge required to complete insurance prior authorization requests for specialty care provider needs.
• Possess the clinical knowledge required to complete pharmaceutical manufacturer-specific forms to obtain medications or medication coverage for specialty care provider needs.
• Possess the knowledge required to complete prior authorization forms for MAP and SFS to obtain medications or medication coverage for patient and provider needs.
• Possess critical thinking skills, good organizational skills and the ability to schedule and prioritize tasks.
• Maintain an exceptional level of communication with patients and ensure they receive status information in a timely fashion.
• Interact respectfully and collaboratively with patients and their families, striving to develop favorable relationships with families.
• Collaborate with all members of the care team in providing patient-centered care.
• Complete all mandatory training and maintain appropriate credentials/licensure.
• Annual completion of 2 hours of required Continuation Education.
• Possess the clinical knowledge required to complete insurance prior authorization requests for specialty care provider needs.
• Ability to communicate effectively with commercial and government insurance plans to process Prior Authorization claims.
• Knowledge of EOB forms and how to evaluate pharmacy benefits per each payor guidelines.
• Knowledge of clinical and lab results to accurately document insurance claims for patient medication therapy.
• Knowledge of each insurance Medication Formularies and Prior Authorization process.
• Organizational skills to follow up with Prior Authorization renewals.

 

Qualifications

MINIMUM EDUCATION:
High School Diploma


PREFERRED EDUCATION:
Associates Degree in Pharmacy Tech


MINIMUM EXPERIENCE:
6+ years of experience as a Pharmacy Technician
1-2 years of Microsoft Excel experience


PREFERRED EXPERIENCE:
1-2 years of ambulatory care


REQUIRED CERTIFICATIONS/LICENSURE:

Registered with the Texas State Board of Pharmacy


PREFERRED CERTIFICATIONS/LICENSURE:
National Certification with the Pharmacy Technician Certification Board

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed