Pharmacy Benefit Technician

🔥 16 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $18 - $29 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💻 IT Support

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

⚕️ Healthcare Insurance

Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• Responsible for following policies and procedures set within the pharmacy department to ensure that Members obtain appropriate medications in a timely, cost-effective, and efficient manner. • Requires use of and proficiency in multiple computer programs. • This job involves a significant amount of time on the telephone handling calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale. • Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member to clarify the intent of the prior authorization and identify any potential missing information. • Enter prior authorizations and formulary exception requests into referral form. • Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review. • Will complete initial and benefit denial letters. • Serve as a liaison with the pharmacy benefit manager (PBM) regarding pharmaceutical questions or issues that arise. • Serve as a resource for other departments within the health plan. • Meet and maintain all benchmark stats while holding this position.

🎯 Requirements

• Pharmacy technicians must have a minimum of a high school diploma or equivalent. • Experience with inpatient and retail pharmacy utilization, as well as a broad knowledge of pharmacy practice is preferred, but not required. • Familiarity with computers and ability to work with multiple programs at the same time is required. • Must have excellent oral and auditory skills for productive interoffice dialogue and Member or provider interactions. • Must be nationally certified (CPhT designation), either through the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association (NHA). • South Dakota: Registration required within 30 days from the date of hire.