This position will work under the supervision of the pharmacist. Requires knowledge of drugs, medical nomenclature, and the metric system to enter data into the computer system to fill prescriptions and to obtain reimbursement/payment. Ability to interpret physicians orders, perform drug calculations, and interpret prescriptions. Serves as a liaison between the customer and the pharmacists, physicians, and third party administrators. Will also take requests for prescription refills and obtain necessary prior authorizations. Available, as scheduled, to answer inbound calls while protecting the confidentiality of member information and adhering to company policies regarding patient health information (PHI). Makes outbound calls as needed, faxes providers offices, and provides exceptional, courteous and professional customer service. Must demonstrate the ability to research complex issues across multiple databases, work with support resources to resolve member issues, and own problems through to resolution on behalf of the member in real time or follow-up with the member as soon as possible.
Input orders efficiently with attention to detail, includes order entry, billing, crediting, and updating medical records. Understand copays, formularies and special pricing to ensure claims are adjudicated correctly and adjustments are performed when applicable.
Must thoroughly investigate and provide documentation to the point of resolution all customer service issues, as well as communicate resolution to appropriate parties. Partner with others to handle and resolve escalated issues when appropriate and act urgently when necessary.
Attends to customers and answers telephones in a courteous and timely manner. Serves as a liaison between the customer and the pharmacist, physician and third party members. May also take requests for prescription refills and obtain necessary authorizations. Works with various parties such as third party payers, providers, and other pharmacies while providing proper documentation for adjudication discrepancies or to obtain prior authorizations when needed.
Meet departmental standards for production and quality improvement strategies, schedule adherence as well as participate in training and self-development opportunities when appropriate.
Research and respond to inquiries or requests from management or internal sources.
Skills and knowledge typically attained with acquiring a Pharmacy Technician license.
Requires current and unrestricted pharmacy technician licensure in the state of practice (where applicable). Pharmacy technician certification required. May be required to possess a valid drivers license.
Demonstrated ability to document and present concepts in a clear, concise, and logical manner through reading, writing, and speaking in person or on telephone with all levels of staff, physicians, patients and other contacts. Must possess good organizational, problem solving and computer skills.
Pharmacy technician experience. Knowledge of medication management information system software and automated dispensing systems.Highly proficient in analyzing complex claim transactions and systems with the ability to effectively define issues, collect data, establish facts, and draw valid conclusions.Ability to follow changing instructions and execute special projects as required and additional duties as assigned.
Additional related education and/or experience preferred.
Internal Number: 257350
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.