Pharmacy Operations Specialist

ICONMA; Remote; ZAR 200 000 - 300 000; Full time

Job summary

A Medical Center company is seeking a Pharmacy Operations Specialist for a remote position. The role involves processing prior authorization requests, applying clinical policy criteria, and providing pharmacy-related customer service. Candidates should have strong organizational skills, attention to detail, and experience in a pharmacy setting. The position offers health benefits and opportunities for growth. Join a progressive team in a supportive environment.

Benefits

Health Benefits

Referral Program

Excellent growth and advancement opportunities

Qualifications

• Minimum of a High School diploma or equivalent.
• Two or more years of experience in a professional or pharmacy setting.
• Excellent written and oral communication skills.

Responsibilities

• Receive and process prior authorization requests.
• Apply clinical policy criteria to authorization requests.
• Communicate with members and providers regarding determinations.

Skills

Customer Service skills

Strong organizational skills

Problem solving skills

Communication skills

Interpersonal skills

Attention to detail

Multitasking abilities

Education

High School diploma or equivalent

Associate or Bachelor’s degree preferred

Job description

Our Client, a Medical Center company, is looking for a Pharmacy Operations Specialist for their Remote location.

Responsibilities

• Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements.
• Properly apply clinical policy criteria to the review of prior authorization requests
• Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email
• Interprets medical and pharmacy data and accurately enters information into system according to regulatory and NCQA accreditation requirements
• Communicate determinations to members and providers via incoming and outgoing telephone calls, fax notifications, and letter notifications
• Responsible for analysis and issue resolution as it pertains to the administration of the formulary and benefits
• Provide pharmacy-related customer service to both internal and external parties.
• Process pharmacy authorizations utilizing PBM real time online claims adjudication software.
• Support new clinical program implementation
• Serve as a liaison to Member Services and other internal clients for real-time support on pharmacy benefit interpretation, Pharmacy Policy interpretation, and plan design interpretation.
• Other responsibilities as needed

Requirements

• General supervision received daily
• Minimum of a High School diploma or equivalent required.
• Associate or Bachelor’s degree preferred
• Two or more years of experience in a professional or pharmacy setting
• Previous experience in a managed care environment preferred
• Prior customer service experience preferred
• Excellent Customer Service skills
• Prior experience assisting members and/or providers with telephone inquiries
• Strong organizational, problem solving, communication, and interpersonal skills
• Excellent written and oral communication skills required.
• Must have strong data entry and attention to detail in building cases
• Must be able to multitask and be results oriented

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.