Specialty Rx Coordinator - Fully Remote

Allied Benefit Systems; Chicago (IL); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life and disability insurance

Paid time off

Tuition reimbursement

EAP

Technology stipend

Job summary

Allied Benefit Systems seeks a Specialty Rx Administrator to bridge the retail and specialty pharmacy with prescribers, documenting, submitting, and communicating outcomes for prior authorizations. The role manages all pharmacy and medical PA requests and assists members facing medication costs while coordinating escalations with external vendors.

The position is remote-friendly, requires a Bachelor’s degree or equivalent experience and at least five years in pharmacy benefits, with strong

Qualifications

• At least 5 years of professional experience in pharmacy/benefits domain.
• Experience with prior authorization processes.
• Knowledge of RA, transplant, Hepatitis C, infectious disease, oncology preferred.
• Strong verbal and written communication.
• Excellent organizational and time management skills.

Responsibilities

• Act as liaison between retail and specialty pharmacy and prescribers to document and submit prior authorization requests.
• Assist members with financial concerns about medications.
• Collaborate with Customer Service to improve processes.
• Submit referrals to third-party vendors managing specialty carve-out programs.
• Review vendor plan language for regulatory impact.
• Coordinate with internal teams on policies and plan language.
• Handle escalated questions and status updates for vendor relationships.

Skills

Verbal communication

Written communication

Organizational skills

Time management

Analytical thinking

Microsoft Office

Education

Bachelor’s degree or equivalent

Tools

Microsoft Office Suite

Job description

POSITION SUMMARYThis Specialty Rx Administrator acts as a liaison between the retail and specialty pharmacy and the prescribers to document, submit, communicate outcomes and appeals. The Specialty Rx Liaison III manages all pharmacy and medical prior authorization requests. They will assist all members who express financial concerns regarding their medications as well as communicate escalations as appropriate.ESSENTIAL FUNCTIONSCollect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacityArrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member’s associated QicLink pageExecute, manage, and provide on-going support of single case agreementsAssist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendorsSubmit member referrals to third-party vendors managing specialty carve-out programsServes as liaison for external vendors when implementing specialty carve-out programsReviews current and newly requested vendor plan language to understand impact with governmental regulationsEnsure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycleCollaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendorManagement of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teamsOther duties as assignedEDUCATIONBachelor’s degree or equivalent work experience required.EXPERIENCE AND SKILLSAt least 5 years of professional experience including comprehension of pharmacy and medical benefits, specialty medications, j-codes and their administration, limited distribution drugs as well as specialty pharmaceutical manager selection required.Prior authorization experience required.Knowledge of medication use in RA, transplant, Hepatitis C, infectious disease, and or oncology preferred.Excellent verbal and written communication skills.Excellent organizational skills and attention to detail.Excellent time management skills with a proven ability to meet deadlines.Strong analytical and problem-solving skills.Ability to prioritize tasks and to delegate them when appropriate.Ability to function well in a high-paced and at times stressful environment.Proficient with Microsoft Office Suite or related software.POSITION COMPETENCIESAccountabilityAnalytical ThinkingCollaborationCommunicationCustomer FocusFunctional ExpertiseInitiativePHYSICAL DEMANDSThis is a standard desk role requiring extended sitting and computer work.WORK ENVIRONMENTRemoteHere at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.