Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Pharmacy Technician II - Ingenio Rx

Responsible for the interpretation and data entry of moderately complex prescriptions, prior authorization processing, and troubleshooting adjudication issues.

Primary duties may include, but not limited to:

Verifies member information and inputs data for the pharmacists.

Educates members on pharmacy based rules related to prescriptions and medication resources or assistance programs.

Processes prior authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations.

Provides resolution to grievances and appeals issues.

Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.

Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports.

Maintains record keeping of prior authorizations, rebates, and monthly reports.

Requires an active, professional license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States; 2 years of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.

For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Additonal Information:

Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the flexibility to return to a regular, in-office work environment. As we continue to monitor guidance from CDC and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities.

Enters and validates information on member prescriptions and reviews member prescriptions in claims system.
Educates providers on pharmacy based rules related to prescriptions and medication resources or assistance programs.
Processes prior authorization requests from physicians offices and ensures compliance with Medicare requirements.
Informs relevant parties of all prior authorization determinations.
Provides resolution to grievances and appeals issues.
Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.

Ability to work the hours of 9:00 am - 5:30 pm EST with 1 required night shift per week from 10:30 am 7:00pm EST and the ability to work overtime as needed.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Qualifications

Requires High School diploma and up to 2 years of pharmacy experience, or any combination of education and experience, which would provide an equivalent background. Requires current State Pharmacy Tech. Certification or National Certification based on applicable state(s) requirements Good computer and written, oral and interpersonal communications skills required.