Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com



JOB SUMMARY:

The Pharmacy Technician may perform duties in one or more of the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center or Prior Authorization.



Using established company guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits. The Pharmacy Technician reviews requests for non-formulary drugs, works with pharmacies to audit for and resolve discrepancies and/or problems, takes member benefit calls, and reviews requests for prior authorization. The technician researches and resolves questions, problems or issues. Receives and analyzes requests for prescription drugs not approved on formulary; relays denial or approval to requester following verification of member benefits, medical diagnosis, and review of information regarding requested prescription drug. Compiles utilization data and prepares various reports for clinical pharmacists. Makes decisions on drugs submitted for reimbursement through claims department not covered or prior approval drugs. May consult with Clinical Pharmacists or Regional Medical Director on quality management, utilization, or other related issue.





ESSENTIAL DUTIES AND RESPONSIBILITIES:


Pharmacy Services Center:

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Takes member inquiry calls for benefit questions including prior authorization requests
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Maintains expert knowledge on all Health Net Medicare Pharmacy benefits and formularies, including CMS regulations as they pertain to this position.
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Educates the member on their specific pharmacy benefit and offers them options including the submission of a prior authorization request
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Process member submitted claims

Qualifications


REQUIREMENTS:

Education:

High School diploma or GED required



Certification/License:

Valid Pharmacy Technician License



Experience:

Two years Pharmacy Technician experience

Customer Service/retail experience preferred



Knowledge, Skills & Abilities:

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Working knowledge of pharmaceutical claims, language, drug usage and generic substitution practices
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Computer skills and working knowledge of Microsoft products, claims processing software and report creation
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Ability to learn new software applications
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Accurate typing of 30 wpm
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Excellent verbal and written communication skills
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Professional telephone etiquette and skills
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Familiarity with Formulary Lists including common edits and restrictions
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Excellent organization skills



OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.