Senior Pharmacy Coordination Specialist — Remote

Highmark Health Company; Nashville (TN); Remote; USD 27,000 - 38,000; Full time

Job summary

Highmark Inc. is seeking a Pharmacy Call Center Specialist to provide frontline guidance and ensure efficient delivery of call center services.

You will review drug benefit design, respond to inquiries regarding oral, injectable, and infusion medications and coordinate with providers and staff to resolve prior authorizations and denials. The role involves analyzing claims history, ensuring compliance with DPW/CMS regulations, and maintaining accurate documentation within OnBase and Argus IPNS

Qualifications

• Minimum: High school diploma or GED.
• Preferred: Associate degree and Pharmacy technician certification.
• Experience in pharmacy claims processing preferred.

Responsibilities

• Communicate with physician and pharmacy network providers to address needs in a courteous, timely manner.
• Interact with staff to implement processes and problem solve.
• Review drug benefit design and prior authorization criteria; manage daily workflow.

Skills

Computer literacy

Interpersonal skills

Organizational skills

Multi-tasking

Education

High school diploma or GED

Associate degree

Pharmacy technician certification

Tools

OnBase

Argus IPNS

Job description

Highmark Inc. is seeking a Pharmacy Call Center Specialist to provide frontline guidance and ensure efficient delivery of call center services.

You will review drug benefit design, respond to inquiries regarding oral, injectable, and infusion medications and coordinate with providers and staff to resolve prior authorizations and denials. The role involves analyzing claims history, ensuring compliance with DPW/CMS regulations, and maintaining accurate documentation within OnBase and Argus IPNS