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#24-004394-0007
Supplemental Questionnaire

Last Name
First Name

 

**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

Describe your clerical experience applying policies in a medical care, health insurance or Federal or State entitlement program.

Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not possess experience in this area, put N/A in the box below.

2

Do you possess one (1) year experience as a Pharmacy Technician?

Yes No
3

If you responded YES to the above question, please describe your one (1) year of experience as a Pharmacy Technician.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

4

Describe your experience in pharmacy operations or other related role.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

5

Describe your knowledge of and/or experience with understanding and interpreting pharmacy benefits processing information and applying it to pharmacy claims adjudication issues.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

6

Describe your knowledge of and/or experience applying program and federal policies and procedures.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box. 

7

Describe your experience with drug formularies.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

8

Describe your experience communicating with pharmacies and clients to obtain appropriate pharmacy billing codes.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

9

Describe your experience using MS Excel spreadsheets and Google Suite Apps such as Docs, Sheets, and Drive.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.


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