Your Role

The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Pharmacy Technician, Intermediate, will report to the Operations Supervisor. In this role you will resolve outpatient pharmacy benefit coverage inquiries, including prescription claim processing problems, and communication of drug formulary guidelines and alternatives.

Your Work

In this role, you will:

• Coordinate, assist in, and support implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit
• Evaluate prior authorization requests based on medication policy and operational principles
• Provide drug usage history and other pertinent pharmacy benefit related inquiries to internal business partners to assist in case specific reviews and drug evaluations
• Communicate with the physician, physician's office staff, pharmacies, and internal business partners to assist with accurate and efficient resolution of pharmacy benefit inquiries
• Clearly communicate formulary alternatives and prior authorization criteria, and discusses pharmacy benefit coverage when required

Your Knowledge and Experience

• Requires a Certified Pharmacy Technician license
• Requires at least 2 years of pharmacy related experience and training; or equivalent combination of education and experience
• Demonstrated ability encompasses basic understanding of internal procedures and policies needed to ensure effective execution of assigned tasks
• Ability to multi-task, set priorities, and manage time effectively
• Strong phone and verbal communication skills along with active listening

Pay Range:

The pay range for this role is: $20.47 to $28.66 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.