Pharmacy Benefit & Compliance Specialist

TeamCare Medical; New York (NY); On-site; USD 55,000 - 60,000; Full time

Job summary

C2Q Health Solutions in New York, NY is seeking a Pharmacy Specialist to ensure medication access and regulatory compliance within the CMS and NY Medicaid frameworks. You will oversee delegated monitoring functions for the CenterLight PACE program and coordinate care with pharmacy teams.

The role requires 2–5 years in retail pharmacy or PBM, strong Excel/Office skills, and ability to generate reports. Work hours are 40 per week, 8:30 AM to 5:30 PM.

Qualifications

• High School Diploma or equivalent required; Pharmacy Technician Certification preferred.
• 2–5 years of Retail Pharmacy, Health Plan, and/or PBM experience preferred.
• Demonstrates knowledge in the field of pharmacy.
• Expert level proficiency with Microsoft applications, including Excel, Word, and PowerPoint.
• Able to create reports and manipulate data sets.
• Self-motivated with ability to work independently with minimal supervision; strong communication skills.

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.
• Analyze and identify inappropriately paid and denied claims with financial implications.
• Act as pharmacy liaison between the clinical pharmacy department and other internal departments.
• Answer or re-direct internal and external questions related to pharmacy and provide research and analysis.
• Review transition fills and assist providers with formulary alternative switch.
• Generate and distribute reports to the Pharmacy Management team and other programs as needed.
• Upload PBM reports to SharePoint and maintain organized documentation.
• Provide support to the pharmacy team on various clinical programs, including care coordination and record keeping.
• Perform additional functions as needed for the operations of the Pharmacy department.

Skills

Communication

Independent work

Data analysis

Report creation

Multilingual

Education

High School Diploma or equivalent

Pharmacy Technician Certification (preferred)

Bachelor's degree preferred (not required)

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

C2Q Health Solutions in New York, NY is seeking a Pharmacy Specialist to ensure medication access and regulatory compliance within the CMS and NY Medicaid frameworks. You will oversee delegated monitoring functions for the CenterLight PACE program and coordinate care with pharmacy teams.

The role requires 2–5 years in retail pharmacy or PBM, strong Excel/Office skills, and ability to generate reports. Work hours are 40 per week, 8:30 AM to 5:30 PM.