Auto req ID 2002BR Company BlueCross BlueShield of WNY About Us BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., one of New York’s leading health care companies that provides access to quality health care and solutions for members throughout Upstate New York. Since 1936, BlueCross BlueShield has helped millions of people gain access to health care. Headquartered in Buffalo, NY, the company is an independent Licensee of the BlueCross BlueShield Association. As the region’s leading health plan, serving over 800,000 members, BlueCross BlueShield believes in taking small steps towards healthier living. You can visit our website at www.bcbswny.com. Title Clinical PharmacyTechnician I Position Posting Location Buffalo Status Full Time Regular Hours 8-5 Job Description This position supports the corporate pharmacists. Coordinates and administers the effective and efficient processing of the pharmacy benefits prior authorization process, ensuring that pharmacy benefits are administered in accordance with all regulatory agency requirements. Primary Responsibility Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines. Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Corporate Pharmacy Department. Maintain regulatory compliance and resolves all cases within predetermined timeframes. Responsible for all preauthorization entries into applicable databases (i.e. internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary. Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others. May perform other non-clinical duties as required by management and department needs. Knowledge and Skills Strong knowledge of medical and pharmaceutical terminology Strong verbal and written communication skills Well organized, paying close attention to detail Ability to identify and resolve problems Ability to handle multiple priorities in a timely manner Strong interpersonal skills Ability to work independently or in a team environment Customer oriented Proficient with Microsoft Office products (i.e. Word, Excel, Powerpoint, etc.) Qualifications Problem Solving Skills: Ability to perform independent research regarding pharmaceuticals and the judgment to make initial decisions and involve pharmacists where necessary.
External Contacts: Providers, retail pharmacies, members, vendors Experience Certified by the Pharmacy Technician Certification Board (PTCB). Minimum of 2 years’ experience as a Pharmacy Technician in a hospital, retail or managed care setting. Education Required Education:Associates Degree (N/A) Certification Certified Pharmacy Technician Working Conditions Must be able to work in an office environment Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc) Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description. EEO Statement All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status. Removal Date 04-Oct-2019