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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing prescriptions, prior authorizations, and ensuring compliance with Medicare requirements. Strong communication and problem-solving skills are essential for educating members and resolving inquiries effectively.
Highest-signal resume keywords
Pharmacy Technician CertificationPrior Authorization ProcessingMedicare ComplianceCall Center ExperienceProblem-Solving Skills
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 GenerationRecord Maintenance
Soft Skills
Oral Communication SkillsWritten Communication SkillsInterpersonal Communication SkillsFacilitation SkillsAnalytical Skills
Certifications & Qualifications
Active Professional LicenseState Pharmacy Technician CertificationNational CertificationPTCB Certification
Industry Keywords
Pharmacy ExperienceFormulary BenefitsGrievances and AppealsMedication ResourcesCOVID-19 Vaccination Requirement
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 pharmacy rules related to prescriptions and medication resources or assistance programs
- Process prior authorization requests from physician offices
- Ensure compliance with Medicare requirements
- Inform relevant parties of prior authorization determinations
- Resolve grievances and appeals issues
- Respond to inquiries from physicians, sales teams, and members regarding formulary and prescription benefits
- Generate reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports
- Maintain records of prior authorizations, rebates, and monthly reports
Requirements
What you’ll need- Active professional license, if required by state law
- State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements
- Authorization to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States
- H.S. diploma or equivalent
- Minimum of 2 years of pharmacy experience
- Alternatively, any combination of education and experience providing an equivalent background
- For the CPCC business area, a current Pharmacy Tech license and certification is required
- Call center experience preferred
- PTCB Certification strongly preferred
- Strong oral, written, and interpersonal communication skills
- Problem-solving skills
- Facilitation skills
- Analytical skills
- Ability to work 12:00 pm–8:30 pm EST, Monday through Friday
- Additional hours, including weekends or holidays, may be required based on operational needs
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- Certain patient/member-facing roles require COVID-19 and Influenza vaccination unless an acceptable explanation is provided
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 with required in-person training sessions
- Flexible work-life integration and autonomy