Pharmacy Coordinator
- prior authorization
- point of sale
Not enough detail in this posting to match
Job Title: Pharmacy Coordinator
Location: Remote Role
Duration: 6 Months CTH possible
The Pharmacy Coordinator provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. This position responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Will interact with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.
Required Qualifications
High School Diploma/GED
3-5 years of Customer Service experience
Pharmacy Experience
Pharmaceutical Knowledge
Pharmacy Benefits Management Understanding
Barrier Identification & Problem Solving
Proficient in Microsoft Suite
Preferred Qualifications
1-3 Healthcare Insurance Experience Strongly Preferred
Bilingual Spanish speaker
Additional Details
Contract only but there could be a possibility of full-time hire if a position becomes available
Must complete the Pharmacy Coordinator Assessment
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