Job Description

Please find below the details:

Position: Pharmacy Services Specialist

Location: Onsite – Orange, CA 92868

Duration: 6 months (Possibilities of extensions/conversion)

Shift: Day 5x8-Hour

Schedule : Monday to Friday, 8:00 a.m. – 5:00 p.m.

Position Summary:

We are seeking a Pharmacy Technician for a full-time temporary role supporting Medicare Part D beneficiaries. This position will focus on pharmacy-related program support, case management, and assisting network pharmacies and providers with claims, billing, and authorization processes.

Key Responsibilities:

• Manage caseloads to ensure resolution of member and pharmacy cases within department standards.
• Assist with drug-specific technical data retrieval and pharmacy operations.
• Support network pharmacies and prescribers with billing, claims processing, eligibility, and authorization issues.
• Resolve pharmacy claims disputes involving various departments and external entities.
• Interpret and communicate Pharmacy program policies and procedures to providers and staff.
• Process pharmaceutical prior authorization and appeals requests per guidelines.
• Coordinate pharmacy services with internal teams and external providers.
• Handle pharmacy-related member complaints and assist in resolving prior authorization requests.
• Complete other assigned projects and duties.

Minimum Qualifications:

• High School Diploma or equivalent.
• 1+ year of Pharmacy Technician experience in ambulatory, community, home infusion, long-term care, or managed care settings.
• Completion of an accredited Pharmacy Technician training program.
• Active Pharmacy Technician registration with the California Board of Pharmacy.

Preferred Qualifications:

• Associate’s degree in a health-related field.
• Pharmacy Technician Certification Board (PTCB) certification.
• Bilingual in English and one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

Skills & Abilities:

• Strong relationship-building skills with internal teams and external contacts.
• Excellent verbal and written communication abilities.
• Ability to work independently, exercise sound judgment, and manage multiple projects in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and job-specific applications.

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