Remote Clinical Pharmacy Specialist: Medicare Coverage Review

BlueCross BlueShield of Tennessee; Chattanooga (TN); Remote; USD 90,000 - 120,000; Full time

Job summary

BlueCross BlueShield of Tennessee is hiring a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members have timely and appropriate access to pharmacy benefits and services. You will collaborate with pharmacists and providers to build and manage cases that affect coverage determinations.

The role blends independent work with teamwork across the pharmacy staff, offering a path to develop specialized knowledge in coverage review while delivering

Qualifications

• High School Diploma or equivalent.
• 2 years of pharmacy experience required.

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

Strong communication skills

Team player

Organizational skills

Ability to work independently

Education

High School Diploma or equivalent

Tools

Microsoft Office (Outlook, Word, Excel, PowerPoint)

Job description

BlueCross BlueShield of Tennessee is hiring a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members have timely and appropriate access to pharmacy benefits and services. You will collaborate with pharmacists and providers to build and manage cases that affect coverage determinations.

The role blends independent work with teamwork across the pharmacy staff, offering a path to develop specialized knowledge in coverage review while delivering