PHARMACY TECH
Location: Baltimore, Maryland
Description: The Judge Group is currently seeking to employ PHARMACY TECH right now, this job will be delegated in Maryland. For detail informations about this job opportunity kindly read the description below. Our client is currently seeking a PHARMACY TECH.
This job will have the following responsibilities:
The Pharmacy UM Operations Specialist will be responsible for completion of day to day ! activities in the Pharmacy Department. The Pharmacy UM Operations Specialist will be responsible for intake of Pharmacy UM requests, and, in conjunction with a licensed pharmacist, will be responsible for completing and/or assisting in the various activities of the pharmacy department related to Part D coverage determinations (exceptions) redeterminations (appeals), and Part B Drug Prior Authorizations (PA) and Appeals. In addition, the Pharmacy UM Operations Specialist carries out other tasks, including supporting and assisting with various QA processes, audits, and other instances where hands-on intervention/participation may be required, or as requested by appropriate supervisory staff. General responsibilities Perform Pharmacy UM Operations Specialist assignments for the day or by special assignment as requested by the Operations Manager, Pharmacy Services. Assist with escalated issues that come to the Pharmacy Department from members, providers, or other CIP department! s. Work with Pharmacy Benefits Manager (PBM) to identify and r! esolve issues. Maintain a strong knowledge of the Part D coverage determinations (exceptions) redeterminations (appeals), and Part B Drug Prior Authorizations (PA) and Appeals processes including all applicable policies and procedures (P&P), Standard Operating Procedures (SOP) and CMS guidance. Accurately and efficiently enter, track and oversee Part D coverage determinations, redeterminations and Part B PA requests on a day to day basis. Interact with Care Improvement Plus a members and physicians' offices on the phone including requesting additional information and making oral decision notifications. Assist with frequent audits to ensure quality and accuracy of contents of case files and database. Assist with additional reports and audits as directed by the Operations Manager or other supervisory staff. Run daily reports and conduct real time audits to ensure all required work is completed and all CMS timelines are met Be able to communicate with other departments and ven! dors to maintain core competencies concerning Pharmacy benefits and Pharmacy UM processes. Escalate issues when required to obtain resolution. Perform other duties as directed by the Operations Manager. Required education and experience high school diploma or equivalent at least one year experience with pharmacy claims processing, Medicare claims processing preferred Required knowledge, skills, and abilities qualified candidates will also have working knowledge of third party medical insurance plans and experience with prior authorizations strong functional computer knowledge including Microsoft office and outlook. Intermediate to highly proficient excel skills required ability to perform tasks with minimal supervision, a high level of accuracy, and strong attention to detail must be a team player and have the ability to interact cross functionally within organization must be able to work autonomously ability to maintain confidential information experience in the use of off! ice equipment knowledge of health care business environment preferred W! e are proud to be an EEO/AA employer m/f/d/v. we maintain a drug-free workplace and perform pre-employment substance abuse testing.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to The Judge Group.
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This job will be started on: Thu, 09 May 2013 03:09:03 GMT