Remote Pharmacy Prior Authorization Utilization Specialist

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

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.