MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position Overview Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.The Medicare Operations Pharmacy Technician is responsible for auditing and validating internal and external reports to ensure proper benefit configuration as well as processing prior authorization requests related to the Medicare Lines of Businesses. The Medicare Operations Pharmacy Technician will also assist in all other Pharmacy department directives.
Job Description- Data entry and processing Medicare prior authorization requests including, inputting, providing notification to members and providers as appropriate.
- Reviews daily claims reports of varying focuses across all lines of business to identify and report on the accuracy of the pharmacy benefit configuration.
- Reviews daily rejection reports to identify and report on inconsistencies or concerns that may impact patient care.
- Validates improper coding through verification between POS and UM platform systems.
- Reviews daily reports to ensure all overrides are inputted correctly and claim adjudication is as intended.
- Reaches out to members, pharmacies, and prescribers to reconcile benefit inconsistencies.
- Reviews external communications for accuracy and appropriateness.
- Assists with coordinating care between members, pharmacies, and providers to improve patient adherence for chronic medications and to promote other pharmacy initiatives including assisting with pharmacy case management activities as needed.
- Assists in preparing documentation for internal and external audits and regulatory submissions as needed
Minimum Qualifications- Associate degree with 4 years' experience as a Pharmacy Technician required.
- Pharmacy experience in a managed care environment preferred.
- Experience in auditing preferred.
- Experience in government programs (Medicare, Medicare Part D, and Medicaid) preferred.
- Proficiency with MS Word, Excel, and PowerPoint is required.
- Proficiency with MS Access is preferred.
Licensure and/or Certification Required
- PTCB or ExCPT Pharmacy Technician Certification required
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication