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Title: Pharmacy Technician - Medicare PDP - CA-Rancho Cordova Location: California-Rancho Cordova Other Locations: Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website .
JOB SUMMARY:
The Pharmacy Technician may perform duties in one or more of the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center or Prior Authorization, Medicare Part D Operations and State Health Programs Pharmacy Operations. Using established company guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits. The technician researches and resolves questions, problems or issues. May consult with Clinical Pharmacists or Regional Medical Director on related issues.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Medicare Part D Operations * Reviews and processes PDE files * Researches and resolves issues using the appropriate reference material * Assists in pharmacy claims corrections projects * Performs audits and quality checks on active prior authorizations claims * Assists with identifying and correcting eligibility and group issues * Processes member claims *
Maintains expert knowledge on all Health Net Medicare Part D benefits and formularies, including CMS regulations as they pertain to this position. State Health programs Pharmacy Operations * Liaison to internal and external departments for SHP pharmacy * Operational issue resolution, including issues from Prior Auth, Appeals and Grievances, and * Member/Provider Services * Preparation and review of various operational reports and audits * SHP formulary management functions, including quarterly formulary updates to website, database and benefit maintenance * Maintenance of prior authorization database files * Medi-Cal DMR processing * Assist with SHP clinical project * Assist with Medi-Cal prior authorizations REQUIREMENTS:
Education: High School diploma or GED required
Certification/License: Valid California Pharmacy Technician License
Experience: Two years Pharmacy Technician experience (This is not an entry level position.) Customer Service/retail experience preferred
Knowledge, Skills & Abilities: * Working knowledge of pharmaceutical claims, language, drug usage and generic substitution practices * Computer skills and working knowledge of Microsoft products, claims processing software and report creation * Ability to learn new software applications * Accurate typing of 30 wpm * Excellent verbal and written communication skills * Professional telephone etiquette and skills * Familiarity with Formulary Lists including common edits and restrictions * Excellent organization skills OR Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
