Pharmacy Intern - MetroPlusHealth : Job Details

Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewThe Pharmacy Intern is responsible for auditing and validating internal and external reports to ensure proper benefit configuration across all lines of business. The Pharmacy Intern will also assist in all other Pharmacy department directives. Job Description

• Reviews daily claims reports of varying focuses across all lines of business to identify and report on the accuracy of the pharmacy benefit configuration.
• Reviews daily rejection reports to identify and report on inconsistencies or concerns that may impact patient care.
• Validates improper coding through verification between POS and UM platform systems.
• Coordinates care between members, pharmacies, and providers to improve patient adherence for chronic medications and to promote other pharmacy initiatives including assisting with pharmacy case management activities
• Reviews daily reports to ensure all overrides are inputted correctly and claim adjudication is as intended.
• Assists in preparing documentation for internal and external audits and regulatory submissions.
• Reaches out to members, pharmacies, and prescribers to reconcile benefit inconsistencies.
• Reviews external communications for accuracy and appropriateness.
• Assists with prior authorization requests including, inputting, providing notification for and reviewing

Minimum Qualifications

• High school diploma/GED, required
• Two years' experience as a Pharmacy Technician, preferred
• Pharmacy experience in a managed care environment preferred
• Experience in auditing preferred
• Experience in government programs (Medicare, Medicare Part D, and Medicaid) preferred
• Proficiency with MS Word, Excel, and PowerPoint is required.
• Proficiency with MS Access is preferred

Licensure and/or Certification Required:

• Pharmacy Intern License, required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

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