Centene Corporation Pharmacy Technician QA in Tampa, Florida
Performs audits related to the prior authorization and appeal process for all lines of business for Pharmacy Services; audits work completed by Pharmacy Technicians associated with verifying the accuracy of reviews and ensures compliance with quality standards, as well as promotes the organization's service standards.
The Pharmacy Q.A audits to determine the integrity and accuracy of regulatory requirements at the Federal, State, and County level, as well as in compliance with departmental policies and procedures, providing statistical data and reports for various functional areas audited to identify continuous quality improvement opportunities.Perform audits of the department’s operational areas to determine compliance with regulatory requirements, corporate contracts as well as company, and departmental policies and procedures.
Collect, analyze, summarize, and thoroughly evaluate and research authorization or appeal requests audited to prepare reports and make recommendations to department management.
Update auditing tools and record accurate reports to manage quality audit results.
Propose recommendations for system enhancements, workflow modifications, processing guidelines, and system and/or training documentation.
Analyze performance data, identify trends, and raise questions regarding policy interpretation throughout all areas of the organization being audited and the departments supporting the work of the audited area.
Consult on and assist in improving operational effectiveness and the development and/or modification of processing guidelines, workflow modification, system enhancements and system documentation to improve operational reliability and efficiency.
High School Diploma, required. Two years experience as a Pharmacy Technician, preferred.
Experience performing medication authorizations in a pharmacy or managed care environment, preferred. Prior experience in quality assurance or auditing, preferred. Proficiency in Microsoft Office: Excel, Word, Access; Facets, CAS and MedHOK systems. Knowledge of common audit techniques and methodologies, including root cause analysis, trending and risk identification. Strong working knowledge of Managed Care/Health Insurance concepts and regulations. Preferred knowledge of government sponsored health insurance programs, enrollment processing and member services functions, as well as within the operational areas under audit. Ability to accumulate daily audit related data and effectively summarize data into management reports by employee, supervisor and at the overall department level. Knowledge in common audit techniques and methodologies including root cause analysis and risk identification. Ability to perform sound data analysis and problem solving skills that include making recommendations to change or improve operational processes. Must have strong analytical and problem solving skills. Skilled to communicate with all levels of management, internal and external customers. Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements.
PTCB or ExCPT Pharmacy Technician Certification, preferred
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
TITLE: Pharmacy Technician QA
LOCATION: Tampa, Florida
COMPANY: Clinical & Care Management
POSITION TYPE: Both