On-Site Clinical Operations Specialist — PBM Care

EmpiRx Health, LLC.; Montvale (NJ); Vor Ort; USD 51.000 - 64.000; Vollzeit

Benefits dieser Stelle

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Zusammenfassung

EmpiRx Health in Montvale, NJ, is seeking a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams, ensuring accurate processing of claims overrides and prior authorizations, and coordinating with stakeholders to sustain service excellence.

This full‑time, on‑site role requires 5+ years of pharmacy experience, including 2 years in claims adjudication and 2 in prior authorization, proficiency with Microsoft Office, and strong

Qualifikationen

• High school diploma required.
• Minimum 5 years of pharmacy experience, including at least 2 years in claims adjudication and 2 years in prior authorization processes.

Aufgaben

• Provide administrative and operational support to adjudication, prior authorization, and clinical review teams.
• Accurately process claim overrides and case documentation in accordance with SOPs.
• Ensure compliance with turnaround times and quality metrics to meet member and client expectations.
• Assist clinical pharmacists and operations teams with workflow management and reporting needs.
• Meet case completion targets and adhere to 2-hour SLA for escalation requests.
• Escalate high-priority or complex issues to leadership as needed.
• Collaborate with internal stakeholders to ensure efficient communication and case handling.

Kenntnisse

Microsoft Office Suite

Attention to detail

Customer service

Deadline management

Critical thinking

Ausbildung

High school diploma

Jobbeschreibung

EmpiRx Health in Montvale, NJ, is seeking a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams, ensuring accurate processing of claims overrides and prior authorizations, and coordinating with stakeholders to sustain service excellence.

This full‑time, on‑site role requires 5+ years of pharmacy experience, including 2 years in claims adjudication and 2 in prior authorization, proficiency with Microsoft Office, and strong