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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing prior authorizations, interpreting prescriptions, and ensuring Medicare compliance while effectively communicating with members and healthcare professionals. Proficient in generating reports and maintaining accurate records in a pharmacy setting.
Highest-signal resume keywords
Pharmacy Technician CertificationPrior Authorization ProcessingBilingual (Spanish)PTCB CertificationPharmacy Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prescription InterpretationData EntryAdjudication TroubleshootingReport GenerationMedicare Compliance
Soft Skills
Problem-SolvingInterpersonal CommunicationAnalytical SkillsFacilitation SkillsOral Communication
Certifications & Qualifications
State Pharmacy Technician CertificationNational CertificationPTCB Certification
Industry Keywords
Prior AuthorizationFormulary BenefitsMedication ResourcesGrievances and AppealsCall Center Experience
About the role
Key responsibilities & impact- Interpret and enter moderately complex prescriptions
- Process prior authorizations
- Troubleshoot adjudication issues
- Verify member information and input data for pharmacists
- Educate members on prescription rules and medication resources or assistance programs
- Process prior authorization requests from physician offices and ensure Medicare compliance
- Inform relevant parties of prior authorization determinations
- Resolve grievances and appeals issues
- Respond to physician, sales team, and member inquiries about formulary and prescription benefits
- Generate rebate, physician utilization, Beers Criteria, Reliance member, and ad hoc reports
- Maintain records of prior authorizations, rebates, and monthly reports
Requirements
What you’ll need- Current active, valid unrestricted professional license, if required by state law
- State Pharmacy Technician Certification or National Certification based on applicable state requirements
- For the CPCC business area, current Pharmacy Tech license and National Certification required
- High school diploma or equivalent
- Minimum of 2 years of pharmacy experience
- Bilingual (Spanish) or multi-language skills required
- Must pass a validated language test/assessment
- Call center experience preferred
- PTCB Certification strongly preferred
- Strong oral, written, and interpersonal communication skills
- Problem-solving skills
- Facilitation skills
- Analytical skills
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work except for required in-person training sessions
- Flexible work-life integration