- Medicaid Pharmaceutical Technician
- What will I be doing?
- Do I qualify?
- Can I be successful?
- How do I apply?
This is responsible technical work in maintaining the routine operation of a pharmaceutical program in the Division of Medical Services.
An employee in this class performs technical work reviewing and evaluating data related to the provision of pharmaceutical services under the Missouri Medicaid Program. Work includes evaluating and developing technical procedures; implementing federally mandated program changes; coordinating inter-unit and inter-agency Medicaid procedures; revising unit and program operations; answering non-routine program inquiries from pharmacy providers and pharmaceutical manufacturing firms; and preparing administrative reports. General supervision for achievement of objectives and efficiency of operation is received from upper-level technical and administrative staff.
Analyzes and evaluates claims data, pharmaceutical manufacturer data, financial data and recurrent statistical data through review of resource materials in order to identify patterns of Medicaid utilization and abuse, program inefficiency and non-compliance; determines appropriate corrective procedures and initiates corrective action.
Reconciles manufacturer rebate remittance reports with quarterly invoices to determine rebate disputes and performs rebate tracking and dispute resolution functions.
Monitors unit and program operations to ensure compliance with federal regulations, procedures and audit recommendations.
Designs and develops procedures for more efficient and economical operations of the unit and associated programs; coordinates implementation of policies and procedures with providers and other agencies.
Assists managers and other staff in developing operating procedures; serves as liaison between program staff and programmers to relay system needs.
Explains and interprets the more difficult and complex rules, regulations and procedures of assigned programs to public officials, providers, recipients, subordinates and other staff members.
Reviews and evaluates detailed claims payment data from reports and notifications in order to identify and initiate recoupment of overpayments.
Identifies provider claim filing errors and initiates actions to recoup Medicaid payments.
Compiles and prepares administrative and technical reports relating to program problems, procedural changes, corrective actions and production statistics.
Reviews and prepares analysis of vendor claims and services and recipient utilization patterns.
Supervises subordinate para-professional and/or clerical staff engaged in the daily operation of a technical unit.
Performs other related work as assigned.
(The following minimum qualifications will determine merit system eligibility. Allowable experience and education substitutions are provided in italics below the corresponding minimum qualification statement. These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
Five years of work experience in one or more of the following areas: assisting in retail or hospital pharmacy dispensing, prescription benefit insurance claims processing, pharmaceutical billings, or comparable record keeping, or similar work; of which two years must have been in an advanced capacity at the level of Pharmacy Assistant II, Clerk III, Account Clerk II or comparable work. (Graduation from a recognized course for pharmacy technicians or education in an accredited college or university in pharmacy, nursing or related areas may be substituted on a year-for-year basis for the general and specialized experience.)
Successful completion of the Pharmacy Certified Technician (PCT) exam.
Two years as a Pharmacy Assistant II under the Missouri Merit System.
Please note that documentation that supports your eligibility (i.e. transcripts, employment records, etc.) may be required at any time during the application and hiring process. If you do not possess the minimum qualifications, please consider one of many other employment opportunities with the State of Missouri.
Do you possess the key skills which are considered essential for successful employment in this classification?
Considerable knowledge of federal and state laws, rules, regulations and procedures governing the operation of the Title XIX Medicaid Program.
Considerable knowledge of pharmaceutical terminology and coding used in the Medicaid Pharmacy program.
Considerable knowledge of pharmaceutical dosage forms, individual dose and prescription preparation, prescription labeling, pharmacy record keeping, and pharmaceutical packaging.
Considerable knowledge of the general procedures used in initiating, processing and evaluating pharmacy claims.
Working knowledge of procedures and techniques of collecting, organizing and evaluating Medicaid and pharmaceutical data.
Working knowledge of the preparation, location and use of computerized information systems, reference manuals, reporting systems and other related resource documents and files used in the operation of the Medicaid program.
Ability to communicate effectively.
Ability to solve technical problems in routine program operation.
Ability to supervise designated subordinates.
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