Nashville PBM Claims & Authorization Specialist

TruDataRx, Inc.; Land Mark (TN); Presencial; USD 55.000 - 75.000; Jornada completa

Descripción de la vacante

TruDataRx, Inc. in Nashville, TN is seeking a PSS - Claims & Authorization Specialist to manage prior authorization workflows within Banjo and assist with PBM claim processing. The role serves as a key internal resource for escalated member and provider concerns and supports the clinical team during case reviews.

The ideal candidate has PBM operations experience, preferably with pharmacy technician credentials, and strong proficiency in Google Workspace and Microsoft Office, plus CRM tools.

Formación

• Minimum 1 year of direct PBM operations experience including medical necessity workflows.
• Pharmacy Technician experience/certification preferred.
• Advanced proficiency with PBM systems, Banjo, and CRM platforms.
• Strong data input, troubleshooting, and member/provider resolution skills.
• Ability to navigate multiple system modules and cross-functional teams.

Responsabilidades

• Manage and execute prior authorization workflows within the Banjo platform.
• Enter and troubleshoot pharmacy claim overrides in PBM systems.
• Provide advanced support to the clinical team during prior authorization reviews.
• Escalate and document complex member or provider concerns.
• Coordinate outbound communications to prescribers, pharmacies, and members.
• Manage operational sub-projects and cross-functional tracking.

Conocimientos

PBM operations

Prior authorization

CRM platforms

Google Workspace

Microsoft Office

Team collaboration

Problem solving

Educación

High school diploma

Herramientas

Banjo

CRM software

Descripción del empleo

TruDataRx, Inc. in Nashville, TN is seeking a PSS - Claims & Authorization Specialist to manage prior authorization workflows within Banjo and assist with PBM claim processing. The role serves as a key internal resource for escalated member and provider concerns and supports the clinical team during case reviews.

The ideal candidate has PBM operations experience, preferably with pharmacy technician credentials, and strong proficiency in Google Workspace and Microsoft Office, plus CRM tools.