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Claims Management - Prior Authorization Pharmacy Technician

Remote, OR 97458, USA Req #645
Wednesday, October 13, 2021

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
 

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

 

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are.  Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

Summary

The Prior Authorization Pharmacy Technician will work as part of the clinical team to assist the pharmacists in all essential functions required for coverage determinations for Medicare beneficiaries. The role is also involved with the development and maintenance of all coverage determination policies and procedures to ensure compliance with all CMS requirements.  In addition, the role will provide insights and suggestions for coverage determination process improvements and operational efficiencies.

 

Pharmastar (a Tabula Rasa HealthCare Group company) is a Pharmacy Benefits Manager (PBM) for commercial plans, Medicare Part D Plans and PACE Plans.

 

Essential Functions:

 

  • Assist pharmacists with coverage determinations for Medicare utilizing PAHub
  • Assist pharmacists with utilization management reviews (i.e., prior authorizations, step therapy, quantity limits, etc.) and determinations for other lines of business including Medicaid, Commercial and PACE. 
  • Assists with the development and maintenance of all coverage determination policies and procedures to ensure compliance with all CMS requirements.
  • Provide insights and suggestions for coverage determination process improvements and operational efficiencies.
  • Effectively communicate with beneficiaries, providers, and clients regarding utilization management decisions and general polices.

 

Secondary Functions:

  • Keep current in the field by reading published information and attending authorized seminars and conferences.
  • Attend all required in-service, meetings, and employee development programs.
  • Serve on various committees or special projects.
  • Other related duties as assigned.

 

The listing of essential functions is not to be considered an exhaustive list of all duties that may be performed.

 

Qualifications:

 

  • High School Diploma or equivalent.
  • CPhT (Certified Pharmacy Technician) certification, required.
  • 2 years of professional work experience in managed care organization or PBM, required.
  • Experience in an environment assisting with coverage determinations utilizing PAHub, required.
  • Knowledge of Medicare regulations and requirements specific to coverage determinations.
  • Proficiency with Microsoft Word, Excel is required. 
  • Proficiency in PowerPoint and Access is preferred.
  • Fluent in Spanish (written and verbal) a plus.

 

Knowledge, Skills, Abilities:

 

  • Knowledge of pharmacology and pharmacological terms.
  • Knowledge of Medicare and other government health care programs.
  • Excellent verbal and written communication skills.
  • Professionalism when working with provider offices, beneficiaries, and all internal stakeholders.
  • Strong customer focus.
  • Exceptional critical thinking and problem-solving abilities.
  • Ability to multi-task and prioritize projects.
  • Ability to work well and interact with departments throughout the organization.
  • Ability to build and manage relationships.
  • Exhibit team player skills and attitude.
  • Able to maintain the highest standard of confidentiality.
  • Strong computer skills including using word processors, spreadsheets, and database software.

 

Supervisory Responsibility:  None

 

Travel:  None

 

Expected Hours of Work: 

 

This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.

 

Physical Demands & Requirements: 

 

  • Communicates by way of the telephone or computer with providers, participants, customers, and vendors.
  • Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
  • Remains stationary for extended periods of time (i.e. sitting on a continuous basis).
  • Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
  • Occasional standing, walking, climbing stairs and reaching to retrieve shelved items
  • Occasional bending/stooping

 

Work Environment: 

 

  • This job operates in a professional office environment with a conversational noise level.
  • No substantial exposure to adverse environmental conditions is expected.
  • Moderate pressure to meet scheduled appointments and deadlines

 

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Other details

  • Pay Type Hourly
  • Telecommute % 100
  • Remote, OR 97458, USA