Pharmacy Benefit & Access Specialist

C2Q Health Solutions; New York (NY); On-site; USD 55,000 - 60,000; Full time

Job summary

C2Q Health Solutions seeks a Pharmacy Specialist to ensure medication access for participants in the CenterLight PACE program. The role requires strong knowledge of CMS and NY Medicaid regulations, oversight and monitoring functions, and coordination with the pharmacy team to resolve claims and formulary issues.

Responsibilities include reviewing daily rejected claim reports, guiding providers on formulary alternatives, assisting with claim issues for dispensing pharmacies, and generating

Qualifications

• High School Diploma or equivalent required.
• Pharmacy Technician Certification preferred.
• Bachelor's degree preferred but not required.

Responsibilities

• Review daily rejected claim report.
• Contact providers/pharmacies informing formulary alternatives when available and/or how to submit Prior Authorization requests and follow up on the cases when necessary.
• Assist dispensing pharmacies with claim issues.
• Analysis and identify inappropriately paid and denied claims that have financial implications both for the pharmacy budget and prevention of financial actions from CMS.
• Act as pharmacy liaison between the clinical pharmacy department and other internal departments. Answer or re-direct internal and external questions related to pharmacy; provide supportive research and analysis as needed and follow through to resolution.
• Review transition fill a report to ensure transition fills are appropriate and assist provider with formulary alternative switch.
• Generate and distribute reports to the Pharmacy Management team and other programs as needed. Upload PBM reports to the Pharmacy SharePoint sites and keeps the document organized and complete.
• Provide support to the pharmacy team on different clinical programs, which includes care coordination with pharmacy/providers, record keeping/tracking, and reporting.
• Perform additional functions as needed for the operations of the Pharmacy department.

Education

High School Diploma or equivalent

Pharmacy Technician Certification

Bachelor's degree

Job description

C2Q Health Solutions seeks a Pharmacy Specialist to ensure medication access for participants in the CenterLight PACE program. The role requires strong knowledge of CMS and NY Medicaid regulations, oversight and monitoring functions, and coordination with the pharmacy team to resolve claims and formulary issues.

Responsibilities include reviewing daily rejected claim reports, guiding providers on formulary alternatives, assisting with claim issues for dispensing pharmacies, and generating