Pharmacy Coordinator-CW

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

Description

Required

• High School Diploma/GED Required
• Must be able to read and speak Spanish
• Pharmacy Experience Required
• Pharmaceutical Knowledge
• 3-5 yrs of Customer Service Required
• Proficient in Microsoft Suite
• Barrier Identification & Problem Solving

Preferred

• 1-3 Healthcare Insurance Experience Strongly Preferred
• Pharmacy Benefits Management Understanding

Please have candidate take "Pharmacy Coordinator" Glider assessment in Glider and provide link of their assessment on resume.

The Pharmacy Coordinator provides front line staff guidance, 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.