Pharmacy Specialist Level 1

ATD Technology LLC; Newark (NJ); On-site; USD 55,000 - 75,000; Full time

Job summary

ATD Technology LLC in Newark, New Jersey, is seeking a Pharmacy Specialist Level 1 to manage prior authorizations and support Pharmacy Services activities, including claim utilization analysis, plan design, ad-hoc reporting, and correspondence.

You will interact with physicians, pharmacies, and patient care teams to determine medical necessity, streamline formulary compliance, and assist in Medication Therapy Management programs, with a focus on accuracy and regulatory compliance.

Qualifications

• Bachelor's degree preferred in Health Care Management, Business or Pharmaceutical Administration.
• Minimum of two years' experience in third-party prescription program claim adjudication.
• Minimum of two years' experience as a Pharmacy Utilization Management Specialist.
• Experience in customer service or service quality initiatives.

Responsibilities

• Process prior authorizations received via help line, evaluating medical necessity.
• Interact with physicians, office staff, pharmacies and internal stakeholders for eligibility and claims issues.
• Intervene to facilitate formulary compliance and generic dispensing.
• Process appeals, complaints, executive inquiries and compliance issues.
• Provide recommendations to increase efficiency, accuracy and productivity.
• Process ad hoc information requests or reports.
• Participate in client member and employee training on pharmacy services.
• Assist in day-to-day pharmacy department operations and Medication Therapy Management programs.
• Support various clinical programs within the pharmacy department.

Skills

Prior authorization processing

Customer service

Pharmacy operations

Interpersonal communication

Education

Bachelor's degree in Health Care Management, Business or Pharmaceutical Administration

Job description

Pharmacy Specialist Level 1

Job Summary

• This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects.
• Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies

Responsibilities

• Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria.
• Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.
• Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
• Process appeals complaints executive inquiries and compliance related issues.
• Provide recommendations to increase efficiency, accuracy and productivity in the department.
• Process ad hoc request for information or reports from stakeholders.
• Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations.
• Assist in the day to day business functions of the pharmacy department as well as the Medication Therapy Management program.
• Provide support to various clinical programs within the pharmacy department.

Education/Experience

• Prefers a Bachelor's degree from an accredited college or university in Health Care Management, Business or Pharmaceutical Administration.
• Requires minimum of two (2) years experience in third party prescription program claim adjudication.
• Requires minimum of two (2) years experience as a Pharmacy Utilization Management Specialist.
• Requires prior customer service/service quality initiative experience.