Pharmacy Services Technician Lead

Candidates must be remote within WA, OR, UT, and ID to qualify for this role.

Primary Job Purpose

The Pharmacy Services Technician Lead is the subject matter expert for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. Provides leadership and mentoring and coaching to other less experienced Pharmacy Technicians and provides higher level Prior Authorization expertise. Participates on the Pharmacy Tech team to assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals.

Responsibilities

• Acts as the team lead; plans and assigns work for team of Pharmacy Technicians and provides on the job coaching to less experienced team members
• Handles more complex Prior Authorization issues and assists with more difficult cases.
• Performs all duties as described in this document unless doing so would require clinical judgment. In any situation in which clinical judgment is necessary, the Pharmacy Services Technician Lead will seek assistance from appropriate medical personnel. Appropriate medical personnel will be available for support during normal business hours.
• Responds to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, pre-authorization nurses, ENCC personnel, and government programs personnel and customer service. These pharmacy issues include formulary drug coverage, appeal and reconsideration claim status, and pricing for drug claims.
• Completes daily formulary operational processes, including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsideration's, and appeals.
• Prepares reconsideration requests for Clinical Pharmacy Consultants review by obtaining and organizing appropriate documentation, including, but not limited to medical chart notes/reports and medication profiles.
• Communicates (orally and by written documentation) information and determinations to providers and members as necessary.
• Obtains and organizes drug utilization data, including patient specific and population based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants. Organizing data includes but is not limited to sorting drugs into appropriate therapeutic and generic categories.
• Assists with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of Regence Health Plan resources, substance abuse, and erroneous and fraudulent billing practices.
• Investigates and organizes workflow for claims referred to Pharmacy Services for review and allowable determination (misc. J codes, providers on review, reconsideration's).
• Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement.
• Contributes to and supports the corporations quality initiatives through process improvement teams and by encouraging team and individual contributions toward the corporations quality improvement efforts.
• Conducts business in compliance with companys Code of Business Conduct, immediately reports violations of the code to management, human resources, internal audit, legal of the compliance officer; and helps in investigating alleged wrongdoing.
• Provides guidance and on the job coaching to less experienced Pharmacy Technicians.
  
  

Minimum Requirements

Demonstrated expert knowledge of Medical terminology and practices including but not limited to:

• Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.
• Health care coding systems such as ICD9, CPT, and HCPCS.
• General office practices and procedures.
• Grammar and techniques of business practice.
• HIPAA regulations
• Demonstrated ability to lead a team of pharmacy technicians, including assigning day to day work, providing practical training and providing informal human capital leadership support.
• Demonstrated ability to interact effectively with a variety of health care professionals, including physicians, nurses, pharmacists, and billing staff both internally and externally.
• Demonstrated maturity, tact, diplomacy, and persuasiveness.
• Ability to perform pharmaceutical pricing calculations.
• Ability to type 45 words per minute with 95% accuracy.
• Demonstrated ability to use MS Office products and other corporate software and other business machines as required.
• Demonstrated broad understanding of the processes and procedures for all areas within the Pharmacy Tech Team.
• Ability to organize, plan, and prioritize daily workflow and projects within time constraints including ability to lead and mentor team members in addition to managing own work load.
• Demonstrated experience with health insurance and/or prescription benefits.
  
  

Normally To Be Proficient In The Competencies Listed Above

The Pharmacy Services Technician Lead would have a high school diploma or equivalent and a minimum of six or more years of experience as a pharmacy technician in a retail, hospital, or other licensed pharmacy setting and some demonstrable leadership experience or equivalent combination of education and experience in a related field. Pharm Tech Certification may be substituted for 2 years of experience. Bachelors degree in general education or related field preferred.

Work Environment

• No unusual working conditions.
• Work primarily performed in office environment.
• May be required to work overtime.
  
  

The base pay starting range for the Pharmacy Services Technician Lead is $21.85-$36.85/hour, depending on candidate's geographic location and experience. The bonus for this position is 5%.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location.

Benefits

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
• paid time off varying by role and tenure in addition to 10 company holidays
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
• one-time furniture and equipment allowance for employees working from home
• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
  
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.