270 OAKWAY CTR Eugene, OR 97401
At Quantum Recruiters we focus intently on providing talent to leading employers throughout the Pacific Northwest. For over 80 years, our client has built a reputation based on taking great care of people by delivering insurance plans to individuals and business throughout the Northwest. We are currently recruiting to fill a full time Pharmacy Tech role.
Position Overview: Coordinate application of pharmacy services and benefits as an integral contributor on the pharmacy team. Handle pharmacy-related inquiries and communicate benefit determinations. Provide pharmacy services helpdesk support to pharmacies, providers, and members. Perform pharmacy authorization and claim processing services.
This position will work Monday through Friday, 8am-5pm - This is not in a retail environment requiring evening/weekend shifts!
- Act as principal contact regarding drug authorizations and system overrides. Help to resolve pharmacy services and benefits inquiries through skillful knowledge of the pharmacy claims, medical claims, and utilization management platforms.
- Initiate clinical review and decision-making of authorization requests under the guidance of clinical pharmacists.
- Effectively communicate and collaborate in a clear and concise manner to internal and external partners, including translating clinical and technical industry jargon to appropriate audiences.
- Function as liaison with pharmacy benefit manager, pharmacies, physicians, and others in order to apply benefits, and assist with pharmacy benefit determinations.
- Consult with clinical pharmacists and other staff in determining coverage for pharmacy-related services and pharmaceuticals.
- Prepare and process member-submitted pharmacy claims in the pharmacy benefit manager’s claims processing system.
- Ensure all coverage determinations are processed in a timely and accurate manner, consistent with Commercial, Medicare & Medicaid regulatory requirements and department policies.
- Serve as primary resource to member and providers for pharmacy questions related to the health plan and in navigating through the health systems.
Work Experience: Minimum two years work in a Pharmacy. Demonstrated ability to work efficiently and effectively with a high attention to detail.
Education, Certificates, Licenses: Minimum high school diploma. Unrestricted pharmacy technician license by the Board of Pharmacy and previously passed National Pharmacy Technician certification exam required. Maintain continuing education requirements for license renewal.
- Good understanding of Medical Terminology required. Familiarity of CPT/ICD-10 codes, home infusion therapies, and specialty medications helpful. Microsoft Office products including Word, Excel, and Outlook.
- Ability to work under time sensitive deadlines. Ability to prioritize responsibilities, diplomatically, handle demanding situations and manage workload with direct supervision. Demonstrate organizational and time management skills.
- Ability to understand and interpret Federal and State specific regulatory requirements helpful. Ability to communicate effectively across all levels of the business on a consistent basis.
Please submit resume for consideration.