Remote Pharmacy Operations Specialist

Trillium Staffing; Boston (MA); Remote; USD 26,000 - 37,000; Full time

Job summary

Trillium Professional is seeking a remote Pharmacy Operations Specialist to support utilization management programs and handle prior authorizations. The role reports to the Pharmacy Operations Manager and does not have direct reports.

The position emphasizes accurate documentation, customer service, and effective communication with members and providers, utilizing PBM software to review eligibility and formulary details.

Pay rate is $23/hour. Equal Opportunity Employer.

Qualifications

• Two+ years of professional or pharmacy experience.
• High school diploma or equivalent.
• Customer service, communication, organization, problem-solving, and data entry skills.
• Ability to multitask and maintain accurate documentation.
• Pre-employment background check.

Responsibilities

• Receive, process, and review prior authorization requests.
• Apply clinical policy criteria and document medical and pharmacy information accurately.
• Review member eligibility, claims history, benefits, and formulary using PBM software.
• Communicate determinations to members and providers through calls, faxes, and letters.
• Resolve pharmacy benefit and formulary issues.
• Process pharmacy authorizations using PBM online claims adjudication software.
• Support clinical program implementation and provide pharmacy guidance to internal teams.
• Follow regulatory and NCQA documentation requirements.

Skills

Customer service

Communication

Organization

Problem-solving

Data entry

Education

High School Diploma

Associate/Bachelor’s degree

Tools

PBM software

Job description

Trillium Professional is now seeking a remote Pharmacy Operations Specialist!

Summary

• Support pharmacy utilization management programs through prior authorization processing, pharmacy benefit interpretation, and member/provider customer service.
• Reports to the Manager of Pharmacy Operations; no direct reports.

Responsibilities

• Receive, process, and review prior authorization requests submitted by fax, phone, and electronic systems.
• Apply clinical policy criteria and document medical and pharmacy information accurately.
• Review member eligibility, claims history, pharmacy benefits, and formulary information using PBM software.
• Communicate determinations to members and providers through calls, faxes, and letters.
• Resolve pharmacy benefit and formulary issues.
• Process pharmacy authorizations using PBM online claims adjudication software.
• Support clinical program implementation and provide pharmacy guidance to internal teams.
• Follow regulatory and NCQA documentation requirements.

Pay rate is $23/hour.

Required Qualifications

• High school diploma or equivalent.
• Two or more years of experience in a professional or pharmacy setting.
• Strong customer service, communication, organization, problem-solving, and data entry skills.
• Ability to multitask and maintain accurate case documentation.
• Pre-employment background check.

Preferred Qualifications

• Associate’s or bachelor’s degree.
• Managed care experience.
• Previous customer service experience.

Trillium is an Equal Opportunity Employer.