Pharmacy Care & Authorization Coordinator

TALENT Software Services; Pittsburgh (Allegheny County); On-site; USD 42,000 - 58,000; Full time

Job summary

TALENT Software Services is seeking a Pharmacy Coordinator to provide frontline guidance and ensure efficient delivery of Pharmacy call center services in the United States. The role includes reviewing provider inquiries regarding oral, injectable and infusion medications, and coordinating with the network to address prior authorizations and claim transitions.

The position emphasizes adherence to health plan drug benefit designs, review of member claims history for medical necessity, and

Qualifications

• High School Diploma or GED required.
• Must be able to read and speak Spanish.
• Pharmacy experience required.
• Pharmaceutical knowledge is required.
• 3-5 years of customer service experience is required.
• Proficient in Microsoft Office.
• Barrier identification and problem solving.

Responsibilities

• Provide frontline staff guidance and ensure effective delivery of Pharmacy call center services.
• Act as first line reviewer to ensure adherence to health plan drug benefit designs.
• Respond to physician and pharmacy network provider inquiries about medications and prior authorizations.
• Review member claims history to define medical necessity and process non-formulary exceptions.

Education

High School Diploma/GED

Pharmacy experience

Pharmaceutical knowledge

Customer service experience (3-5 yrs)

Spanish language skills

Microsoft Office

Problem solving / barrier identification

Healthcare insurance experience (1-3 yrs)

Pharmacy Benefits Management knowledge

Tools

Microsoft Office Suite

Job description

TALENT Software Services is seeking a Pharmacy Coordinator to provide frontline guidance and ensure efficient delivery of Pharmacy call center services in the United States. The role includes reviewing provider inquiries regarding oral, injectable and infusion medications, and coordinating with the network to address prior authorizations and claim transitions.

The position emphasizes adherence to health plan drug benefit designs, review of member claims history for medical necessity, and