Pharmacy Analytics Specialist | Prior Auth & Coverage

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

Job summary

Community Health Choice, Inc. in Houston seeks a Pharmacy Program Specialist within the Pharmacy Analytics department.

Under the Director of Pharmacy Analytics, you will respond to external customers including physicians, office staff, pharmacy providers, members, and brokers, and resolve outpatient pharmacy benefit coverage and prescription claim problems. You will communicate formulary guidelines, including prior authorization criteria and eligibility issues.

Qualifications

• HS Diploma or GED required.
• Texas State Board of Pharmacy registration as a pharmacy technician (CPhT) in good standing required.
• Bachelor's degree preferred.
• At least 1 year of related function experience required.
• Minimum 1 year experience with a health plan or PBM preferred.
• Microsoft Office proficiency.

Responsibilities

• Assist with processing medication prior authorization and appeal requests within required turnaround time.
• Monitor and process medication override requests and communicate approvals to PBM within turnaround time.
• Answer questions regarding pharmacy benefit and coverage of medical injectables under medical benefit.
• Resolve coverage issues with PBM pertaining to covered drugs, copays, prior authorization, and appeals.
• Make outreach to members and providers to improve medication adherence.
• Assist with generating reports and monitor delegated PBM functions.
• Outreach to resolve medical requests within turnaround time.
• Contribute to departmental goals and process improvement plans.

Skills

CPhT

Customer service

Education

HS Diploma or GED

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Community Health Choice, Inc. in Houston seeks a Pharmacy Program Specialist within the Pharmacy Analytics department.

Under the Director of Pharmacy Analytics, you will respond to external customers including physicians, office staff, pharmacy providers, members, and brokers, and resolve outpatient pharmacy benefit coverage and prescription claim problems. You will communicate formulary guidelines, including prior authorization criteria and eligibility issues.