Pharmacy Technician II - CarelonRx Call Center
Core
Interpret moderately complex prescriptions, process prior authorizations, and troubleshoot adjudication issues for Medicare, Medicaid, and Commercial members.
Role type
Licensed pharmacy technician (call center)
Builds
Prior authorization determinations and member education on prescription rules
Domain
Healthcare / Pharmacy benefits administration
Deliverable
client delivery
Required skills
Prescription interpretation, prior authorization processing, data entry, Medicare compliance, grievance/appeals resolution, formulary knowledge
Preferred skills
Medicare member support, high-volume call center experience, medication adherence discussion, multitasking, patient care
Technologies
Computer systems for data entry and reporting
Responsibilities
Verify member information and input data for pharmacists; Educate members on pharmacy rules and assistance programs; Process prior authorization requests and ensure Medicare compliance; Provide resolution to grievances and appeals; Respond to inquiries from physicians and members regarding benefits; Generate reports on rebates and utilization