Remote Clinical Pharmacy Specialist - Coverage & Appeals

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); Remote; USD 70,000 - 90,000; Full time

Job summary

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Commercial and Exchange coverage review activities.

You will collaborate with pharmacists and providers to build cases and contribute to coverage determinations that impact member care in a remote environment. The role emphasizes strong organizational skills, attention to detail, and the ability to navigate complex information.

Qualifications

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

Responsibilities

• Enter authorizations and test claims in the PBM system to ensure proper adjudication.
• Handle calls from providers/members to support coverage determinations and appeals.
• Monitor emails and FACETs inquiries from internal customers regarding pharmacy reviews, appeals, claims issues.
• Review daily pharmacy reports to ensure appropriate claims processing.
• Assist with departmental audits and quality improvement activities.
• Possibility to work evenings, holidays and weekends to ensure adequate coverage.

Skills

PTCB Certified

MS Office

Communication skills

Team player

Independent work

Pharmacy terminology

Education

High School Diploma or equivalent

Job description

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Commercial and Exchange coverage review activities.

You will collaborate with pharmacists and providers to build cases and contribute to coverage determinations that impact member care in a remote environment. The role emphasizes strong organizational skills, attention to detail, and the ability to navigate complex information.