To provide data coordination and clerical support to the Health Services Pharmacy Department, including Treatment Authorization Request (TAR), Coverage Determination Form (CDF) data entry, compilation of reports, and pharmacy provider communication. This position requires skills involved with preparing, organizing, implementing and coordinating pharmacy related activities.
ESSENTIAL DUTIES AND RESPONSIBILITIES
65% - Data Entry:
30% - Planning/Organizing/Coordinating:
- Extracts and compiles information from databases to produce drug-specific, member-specific, and provider-specific reports (i.e. Complex Case Management, Care Coordination, and pharmacy history reports using Business Objects).
- Interacts and responds to provider inquiries regarding TARs/CDF, pharmacy benefits and billing procedures.
- Interacts with PBM regarding formulary processing issues (coordination of benefits, TARs).
5% - Clerical Support:
- Maintains Excel and Word documents, and provides weekly, monthly composite reports,
- Assists with training new staff and writing Desktop Procedures.
- Supports the Pharmacy Department by answering phone calls from providers and pharmacies.
- Enters data into system for TARs/CDF.
- Supports the Pharmacy Department by generating letters to providers and members, sorting and distributing mail, answering telephones, copying, faxing, and filing.
- Creates PowerPoint presentations for pharmacy management.
- Faxing of TAR determinations and maintenance of archived TARs and file.
- Processes Transition Letters.
SECONDARY DUTIES AND RESPONSIBILITIES
- Serves as back up to Pharmacy Assistant/Data Coordinator and support staff during their absence.
- Participates in special projects, assignments, and other tasks as needed.
Education and Experience
High School diploma or equivalent; minimum two (2) years data processing experience in a health care environment; or equivalent combination of education and experience. Pharmacy setting (i.e. retail pharmacy or hospital pharmacy) work experience, or education/training preferred.
Special Skills, Licenses and Certifications
Experience with Windows and related applications and familiarity with data base applications. Knowledge of medical terminology and ability to understand and interpret medical decision making process. Knowledge of alpha-numeric filing systems. Typing speed of 40 wpm and proficient use of 10-key calculator. Knowledge of general business office machine operations. Must have excellent phone answering skills and customer service.
Performance Based Competencies
Effective written and oral communications. Good organization skills to work on multiple assignments simultaneously, prioritize work, and complete tasks within established time frames. Ability to effectively exercise good judgment. Ability to handle calls and sensitive issues with confidentiality, tact and diplomacy
Work Environment And Physical Demands
Standard cubicle work station with shared common area. Use of telephone, fax, computer, and copy machine is required. Requires sitting in front of computer equipment and talking on the telephone for a major portion of the work day. Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. Ability to prioritize work load and initiate action to acquire needed information from professionals by phone. Ability to function effectively with frequent interruptions and directions from multiple team members. When necessary, ability to lift, carry or move manuals and reports weighing up to 25 lbs
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
Partnership HealthPlan of California - 30+ days ago
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