Pharmacy Services Technician

🕒 June 28

🥔 Idaho, Oregon, +2 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $20 - $30 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Perform all duties as described unless clinical judgment is required, in which case seek assistance from appropriate medical personnel who will be available for support during normal business hours • Respond to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, government programs personnel, and customer service regarding formulary drug coverage, appeal and reconsideration claim status • Complete daily formulary operational processes including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals • Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation including medical chart notes, reports, and medication profiles; communicate information and determinations to providers and members orally and through written documentation as necessary • Obtain and organize drug utilization data including patient-specific and population-based data in a manner that facilitates clinical review and decisions by Clinical Pharmacist Consultants, including sorting drugs into appropriate therapeutic and generic categories • Assist with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices; investigate and organize workflow for claims referred to Pharmacy Services for review and allowable determination including miscellaneous J codes, providers on review, and reconsiderations • Support wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement; contribute to and support the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts

🎯 Requirements

• High school diploma or related certificate required • Three years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting, or equivalent combination of education and experience • Pharmacy Technician certificate may be substituted for two years of experience • Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS, and HIPAA regulations • Knowledge of pharmaceutical products including orals, injectables, infusion products, and chemotherapy • Ability to interact effectively with a variety of health care professionals including physicians, nurses, pharmacists, and billing staff • Demonstrated ability to perform pharmaceutical dosing calculations and operate a variety of standard business machines including calculators and faxes • Ability to type 30 words per minute (60 wpm preferred) with basic computer program skills including Word, Excel, and other standard applications • Ability to organize, plan, and prioritize daily workflow and projects within time constraints; experience with health insurance and/or prescription benefits preferred • Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

🏖️ Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. • Annual employer contribution to a health savings account. • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). • Award-winning wellness programs that reward you for participation. • Employee Assistance Fund for those in need. • Commute and parking benefits.