Pharmacy Analytics & Coverage Specialist

Harris Health; Houston (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

Harris Health seeks a Pharmacy Program Specialist within its Pharmacy Analytics department to provide efficient, accurate responses to external customers such as physicians, office staff, providers, members, and brokers. You will resolve outpatient pharmacy benefit coverage and prescription claim problems and communicate formulary guidelines and prior authorization criteria.

You will assist with processing prior authorizations, monitor overrides, answer questions about injectable medications,

Qualifications

• HS Diploma or GED required.
• Registered with the Texas State Board of Pharmacy as a pharmacy technician (CPhT) required.
• Bachelor's degree preferred.
• 1 year in related functions required.
• 1 year experience with a health plan or PBM preferred.
• Proficiency with Microsoft Office.

Responsibilities

• Assist with processing medication prior authorization and appeal requests within required turn-around time.
• Monitor and process medication override requests and communicate authorization to PBM.
• Answer questions regarding pharmacy benefit and coverage of medical injectables.
• Resolve coverage issues with PBM for covered drugs and prior authorizations.
• Make outreach to members and providers to improve medication adherence.
• Assist with generating reports and monitor delegated PBM functions.

Skills

Customer service

Communication

Education

HS Diploma or GED

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Harris Health seeks a Pharmacy Program Specialist within its Pharmacy Analytics department to provide efficient, accurate responses to external customers such as physicians, office staff, providers, members, and brokers. You will resolve outpatient pharmacy benefit coverage and prescription claim problems and communicate formulary guidelines and prior authorization criteria.

You will assist with processing prior authorizations, monitor overrides, answer questions about injectable medications,