Pharmacy Technician (Formulary Analyst)
Leon Health is seeking a Pharmacy Technician. The requirements for this position are:
- A valid Florida Pharmacy Technician License
- National Certification (CPHT)
- At least 3 years of experience working supporting comprehensive coordination of Medicare Part D pharmacy services; including intake and processing of pharmacy authorization requests
- Current/recent Pharmacy Benefit Manager (PBM), or managed care pharmacy experience preferred.
- Responsible for the rejected pharmacy claims review and ensure pharmacy claims follow plan’s pharmacy benefit structure and CMS regulations.
- Perform claims reviews and proactively research information to determine the appropriate coverage in each case.
- Oversee plan formularies in claims processing systems.
- Assist with member and provider communications regarding formulary changes.
- Review paid claims for quantity and/or billing discrepancies. Corresponds with pharmacies as needed to communicate review findings.
- Research and resolve issues using the appropriate reference material.
- Use reports to perform audits and quality checks on the current formulary status for accuracy and compliance.
- Maintain expert knowledge of pharmacy benefits and formularies, including CMS
- Pharmacy Technician ensures Leon Health members have access to all medically necessary prescription drugs and those drugs are used cost-effectively and safely. The job is responsible for guaranteeing Leon Health Plan's pharmacy coverage determination process follows all federal and state laws. The position supports the pharmacy service operation and promotes an optimum level of customer service to members and providers.
Job Status: Full Time