Pharmacy Specialist Level 1 - Newark, NJ (Remote)

Alpha Business Solutions; Newark (NJ); Remote; USD 35,000 - 40,000; Full time

Benefits offered by this job

Pay rate $17-19/hr

Medical for full time employees

Dental and Vision Insurance

Life Insurance and Disability

Job summary

Horizon Blue Cross Blue Shield in Newark, NJ is seeking a Pharmacy Specialist to receive verbal and written prior authorization requests and support Pharmacy Services activities including claim utilization analysis, plan design, ad-hoc reporting, and special projects.

The role requires at least two years in third-party prescription program claim adjudication and as a Pharmacy Utilization Management Specialist, plus customer service experience.

Qualifications

• Prefers a Bachelor's degree 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.

Responsibilities

• Process prior authorizations received via help line, evaluating medical necessity for drugs.
• Interact with physicians, office staff, pharmacies and stakeholders for eligibility and claims issues.
• Facilitate formulary compliance and generic dispensing through physician and pharmacy coordination.
• Process appeals, complaints and compliance related issues.
• Provide recommendations to increase efficiency, accuracy and productivity.
• Respond to ad hoc information or report requests from stakeholders.
• Participate in client member and employee training on pharmacy services.
• Assist in day-to-day business functions and the MTM program.

Skills

Prior authorization

Customer service

Interdepartmental communication

Clinical program support

Education

Bachelor's degree in Health Care Management or related field

Job description

Title: Pharmacy Specialist

Location: Newark, NJ (Remote)

Duration: 6+ Months (Possible extension)

Client: Horizon Blue Cross Blue Shield

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.

Benefits

• [Pay Rate]: $17 - $19 per Hour
• Note: Pay rate will be commensurate with experience.
• Medical for full time employees
• Dental, and Vision Insurance
• Life Insurance, Short-Term Disability, Long-Term Disability, etc.