Location: US-Texas

Job Number: 19201610

CTG, Inc. is seeking a Remote Pharmacy Technician for a six-month contract with our client. Candidate can be located in any state.

Required: CPhT certification required. Possible for permanent role in future.

We are seeking a talented individual for a Remote Pharmacy Technician (Pharmacy TPL Technician) who performs research analytics to support our coordination of benefits (COB) line of business. Assists in the research and development of new recovery methodologies for post-payment recovery of pharmacy claims that may not have been properly coordinated at point of sale.

Essential Responsibilities: Researches pharmacy claims with identified third-party liability coverage, billing and reimbursement policies (through review of manuals/regulations and outreach to PBMs, plans and/or prescribing doctors) to recover funds paid out of turn. Organizes, documents, and communicates results. Applies knowledge of pharmacy billing to research of client policy and data to reveal new t recovery opportunities. Works with internal stakeholders and external pharmacies and doctors to develop recovery streams. Participates in the review of pharmacy claim rejections and denials and member eligibility information to uncover trends associated with non-compliance or misapplication of payment policies, medical policies, billing guidelines, and/or applicable regulatory requirements. Documents results and supports preparation of internal and external documentation and presentations related to research and new coordination of benefit issues. Works with internal operations and clinical teams to develop and implement review/audit/recovery protocols and internal review guidelines. Tracks, and follows-up on results and recoveries.• Develops and validates workflows and communication tools to best enhance production, client satisfaction, and quality assurance. Works with IT to develop and implement technological improvements that will support the coordination of benefit process. Develops business criteria to maximize the identification of COB pharmacy recovery opportunities. Contributes new ideas for improving existing recovery processes. Works cohesively with the program team and the client• Develops, maintains, and ensures adherence to multiple project schedules. Assists in preparing presentations and proposals to internal and external clients. Performs other functions as assigned

Knowledge, Skills and Abilities: Excellent conceptual and analytical skills Good project management skills Ability to develop, organize, and maintain project plans and agendas Ability to effectively interface with clients on the phone and in person Strong working knowledge of Microsoft Suite of products (Excel, Word, Access) Basic Knowledge of SQL preferred Understanding of pharmaceutical terminology. Understanding of Medicare Part D required, Medicaid experience a plus.• In depth knowledge of D.0 claim formats and requirements required. Medical (1500) claim formats a plus.

Work Conditions and Physical Demands: Primarily sedentary work in a general office environment Ability to communicate and exchange information Ability to comprehend and interpret documents and data• Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.) Requires manual dexterity to use computer, telephone and peripherals May be required to work extended hours for special business needs May be required to travel to corporate office minimally based on business needs

Minimum Education: High school diploma or GED required; Bachelor’s degree preferred• CPhT certification required

Minimum Related Work Experience: 4 years of pharmaceutical reimbursement experience at a Pharmacy Benefits Manager (PBM). Retail pharmacy experience is a bonus. Must have demonstrated experience and knowledge of pharmacy claims processing (Medicaid, Medicare, Commercial Insurance), including prior authorization (PA) experience required. Experience in auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred. Experience applying published healthcare guidelines such as D.0 regulations and coding guidelines to claims data

Candidates may apply now or email resumes to martin.dyson@ctg.com


CTG (NASDAQ: CTG) provides industry-specific IT services and solutions that address the business needs and challenges of clients in high-growth industries in North America and Western Europe. CTG also provides strategic staffing services for major technology companies and large corporations. Backed by more than 50 years of experience and proprietary methodologies, CTG has a proven track record of reliably delivering high-value, industry-specific staffing services and solutions to its clients. CTG has operations in North America, Western Europe, and India.

CTG's greatest asset is its people, and as such, we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work in Healthcare company by Modern Healthcare (2013-2016) in North America, and a Best Workplace in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Job: Technology & Healthcare IT