Senior Pharmacy Coordination Specialist (Remote)

Highmark Health Company; Denver (CO); Remote; USD 27,000 - 38,000; Full time

Job summary

Highmark Inc. is seeking a Pharmacy Call Center professional to guide frontline staff and ensure efficient delivery of Pharmacy call center services.

The role reviews medical necessity for non-formulary and prior authorization requests and collaborates with the physician network to address inquiries and authorizations. The position supports a remote work arrangement with defined hours EST and requires knowledge of drug benefit design, formulary terminology, and regulatory requirements.

Qualifications

• Minimum: High school diploma or GED.
• Experience in pharmacy prescription claims processing/submission/payment.
• Preferred: Associate degree.
• Pharmacy technician certification.
• Experience working in a managed care medication formulary management environment.
• Working knowledge of retail pharmacy and/or third party prescription procession.
• Strong background and understanding of medications and formulary terminology.

Responsibilities

• Communicate effectively with physician and pharmacy network providers to ensure needs of provider and plan member are addressed.
• Interact with staff to implement processes and problem solves.
• Respond to drug benefit design inquiries or exception requests and evaluate/direct daily workflow within the department.
• Prioritize requests for drug authorizations or denials.
• Review of prior authorization criteria for drug products.
• Identify and report improper coordination of benefit billing practices through paid claims review.
• Participate as pharmacy representative in onsite member appeals and grievances sessions.

Skills

Excellent computer skills

Interpersonal skills

Organizational skills

Communication skills

Teamwork

Multi-tasking

Education

High school diploma or GED

Associate degree

Pharmacy technician certification

Tools

OnBase

Microsoft Outlook

Microsoft Word

Job description

Highmark Inc. is seeking a Pharmacy Call Center professional to guide frontline staff and ensure efficient delivery of Pharmacy call center services.

The role reviews medical necessity for non-formulary and prior authorization requests and collaborates with the physician network to address inquiries and authorizations. The position supports a remote work arrangement with defined hours EST and requires knowledge of drug benefit design, formulary terminology, and regulatory requirements.