Medicare Advantage (MA) Pharmacy Services Technician


(Arkansas 300)
Full Time
Job Posting Details
About QualChoice
QualChoice Health Insurance is your trusted partner in providing the best value in health benefits for your employees or customers — or for you and your family. Our friendly, personal service and track record of treating people right are one reason we’re the quality choice for health insurance in Arkansas.
The primary role of the MA Pharmacy Services Technician is to assist the Pharmacy Services Department in administering quality improvement processes in compliance with Medicare Part D guidelines across all Prominence Health plans.
* Maintain CMS compliance in all activities performed. * Serve as primary reviewer of Part D appeals using established guidelines and criteria * Perform outreach to internal and external parties to obtain clinical information to support decision making within scope of licensure * Assist with education of staff on pharmacy related Medicare Part D topics. * Interact with network pharmacies to maintain Point-of-Sale (POS) intervention program * Research and conduct outreach to external parties to obtain information to support compliant claims detail tracking and POS adjudication in support of beneficiary access to medications. * Develop and maintain POS edit tracking database with ability to report results to compliance department * Research and correction of clinically related issues found in overall Part D claims adjudication * Attend and support pharmacy operations and cross-functional meetings as required. * Work with PBM to address and resolve operational issues as needed. * Maintain knowledge of Prominence Health Plan Services, Inc. policies, benefits, and structure. * Support formulary and clinical program development by coordinating internal and external parties to maintain compliance with CMS beneficiary notification and web-posting requirements. * Assist with the pharmacy utilization review and reporting processes. * Support Medicare Quality Improvement related projects and initiatives as needed. * Serve as a liaison between pharmacy department and cross-functional areas for process and policy development. * Contribute to team efficiencies by serving as a pharmacy representative in the support of Quality and Care Management departments and initiatives. * Be a pharmacy resource for other cross-functional departments. * Support pharmacy department in developing a successful multi-market expansion strategy.
Ideal Candidate
* High school diploma or equivalent. * 3+ years of pharmacy experience, preferably in a managed care/health plan environment. * Medicare experience preferred. * Complete pharmacy technician training from an accredited Pharmacy Technician training program, or equivalent experience, preferred. * Knowledgeable of all aspects of Microsoft Office to include Outlook, Word, Excel, etc. * Demonstrated excellent customer service skills with internal and external customers required. * Broad-based, working knowledge of managed care pharmacy operations required. * Ability to work effectively in a fast-paced, dynamic environment required. * Strong abilities in verbal and written communication with diverse audiences required. * Demonstrated experience with effective time management working with minimal supervision and successful handling of multiple projects simultaneously and prioritize work appropriately. * Experience working with all levels of staff and medical practitioners including members, physicians, nurses, and providers. * Demonstrated initiative in organizing and prioritizing work to meet deadlines. * WA State or AR Pharmacy Technician registration/license required.


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