Pharmacy Coordinator-CW

Talent Software Services; Pittsburgh (Allegheny County); On-site; USD 45,000 - 65,000; Full time

Job summary

Talent Software Services seeks a Pharmacy Coordinator to guide frontline staff and ensure efficient delivery of Pharmacy call center services. You will respond to physician and network inquiries regarding medications and prior authorizations.

You will review member claims history to define medical necessity for non-formulary and PA requests, and collaborate with pharmacy providers to address denied POS claims and coordination of benefits procedures.

Qualifications

• High School Diploma or GED required.
• Pharmacy knowledge and experience.
• 3-5 years of customer service.
• Proficient in Microsoft Suite.
• Barrier identification and problem solving.

Responsibilities

• Provide frontline staff guidance and ensure efficient delivery of Pharmacy call center services.
• Respond to physician and network provider inquiries regarding medications and prior authorizations.
• Review member claims history to define medical necessity for non-formulary and PA requests.
• Interact with pharmacy network providers to address denied POS claim transitions and COB practices.

Skills

Customer service

Problem solving

Pharmacy knowledge

Education

High School Diploma/GED

Tools

Microsoft Suite

Job description

The Pharmacy Coordinator provides frontline staff guidance and ensures effective and efficient delivery of Pharmacy call center services. Serves as first-line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. This position responds to physician and pharmacy network provider inquiries concerning oral, injectable, and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Will interact with pharmacy network providers to evaluate, educate and/or assist in addressing denied point-of-sale prescription claim transitions and coordination of benefits practices/procedures.

Required :

• High School Diploma/GED Required
• Pharmacy Experience Required
• Pharmaceutical Knowledge
• 3-5 yrs of Customer Service Required
• Proficient in Microsoft Suite
• Barrier Identification & Problem Solving

Preferred:

• 1-3 years of Healthcare Insurance Experience Strongly Preferred
• Pharmacy Benefits Management Understanding
• Bilingual (Spanish)