Remote Clinical Pharmacy Specialist - Coverage & Appeals

bcbst; Chattanooga (TN); Remote; USD 60,000 - 90,000; Full time

Job summary

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members access to pharmacy benefits and services.

You will collaborate with pharmacists and providers to build and manage cases, contributing to coverage determinations that impact member care. The role balances independent work with team collaboration and offers an opportunity to develop specialized knowledge in coverage review in a remote

Qualifications

• High School Diploma or equivalent.
• 2 years of pharmacy experience required.
• National Certification as Pharmacy Technician (PTCB) or similar certification preferred.

Responsibilities

• Enter authorizations and test claims into the pharmacy benefit system to ensure appropriate claim adjudication.
• Handle incoming and outgoing phone calls from providers and/or members/members representatives to assist in completing coverage determinations and appeals.
• Monitor and answer emails and FACETs inquiries from internal customers regarding pharmacy reviews, appeals, claims issues, etc.
• Review daily pharmacy reports to ensure appropriate claims processing.
• Assist with departmental audits and quality improvement activities.
• May be required to work evenings, holidays and weekends to ensure adequate coverage to meet the business needs including on call rotations

Skills

PTCB

Microsoft Office

Team player

Organized

Communication skills

Problem solving

Independent work

Pharmacy terminology

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members access to pharmacy benefits and services.

You will collaborate with pharmacists and providers to build and manage cases, contributing to coverage determinations that impact member care. The role balances independent work with team collaboration and offers an opportunity to develop specialized knowledge in coverage review in a remote