Pharmacy Technician- Member Services - Curative HR LLC

Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health plan reinvented for a post-pandemic world that is built around whole-person affordable preventive care featuring more benefits. Curative is looking for a Pharmacy Technician who is passionate about helping the company as we work to reinvent healthcare options.  Candidates will be able to utilize their previous experience in Pharmacy Operations/Customer Care by increasing satisfaction and retention by providing Curative health plan Members, patients, and providers with accurate, consistent, timely and meaningful information. They will provide support to Members’ while building rapport and collaborative relationships with current and prospective Members in accordance with compliance guidelines.  This is a remote position with multiple shift options in a 24/7 call center.

ESSENTIAL DUTIES AND RESPONSIBILITIES 

• Monitoring for prescription claims rejections from 3rd party pharmacies

• Outreach to members and providers with information regarding rejection and offering alternative options as applicable

• Working with the Curative pharmacy prior authorization team discussing PA decisions with members and providers as needed

• Evaluating extenuating requests and processing overrides as appropriate in the CAPRx JUDI system

• Working with the Pharmacy team on non formulary drug alternatives for member and provider notification

• Contact 3rd party pharmacies to reprocess claims, notify of drug alternatives, prior authorization status.

• Correct claims and prior authorization request as needed

• SME on pharmacy and drug benefits handling escalated contacts from members, providers, pharmacies, and member service team

• Escalation support for after hours issues resolution as needed

• Processing notifications to members services team for member outreach and status updates on prescription status

• Working with leadership team on policy and process improvements

• This position assumes and performs other duties, project management and data reporting as assigned

• Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).

QUALIFICATIONS  

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Excellent attendance is critical to success in this position

• Internal candidates must have been in their current role for at least 6 months and have no performance or attendance actions in effect. 

• Excellent computer and phone skills, attention to detail, process and policy adherence

• Excellent verbal and written communication skills.

• Strong interpersonal skills.

• Active listening skills to accurately respond to inquiries and requests.

• Exceptional organizational skills, retention of policy and process a must

• Intermediate skills minimum in google and microsoft office suite of products a must

• Experience with Dialpad (or other VOIP phone systems) preferred but not required

• Experience with Helpscout (or other email ticket systems) preferred but not required

• Experience with JUDI (or other prescription claims systems) preferred but not required

• Experience with slack, gmail, zoom conference preferred but not required

EDUCATION and/or EXPERIENCE 

• Minimum 5 years experience in pharmacy or PBM operations

• Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS 

• Active PTCB certification required

WORK ENVIRONMENT  

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Remote position

• Must have a quiet place, secure, with no distractions to perform duties for work from home

• Must have password protected, stable internet access - stipend will be provided

• Work location MUST be secure and private to maintain HIPAA compliance for work from home

• Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset

• While performing the duties of this Job, the employee is regularly required to sit; use hands to type, talk; and hear.

• The employee is frequently required to reach with hands and arms.

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

• We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment.  Any request within the first 120 days if approved will be unpaid

• For this position the percentage of expected Travel is:0% of the time