PURPOSE OF THE POSITION:
Provide administrative support for the reporting, communications, clinical programs and vendor oversight functions of pharmacy management operations.
- Receive pharmacy benefit telephone calls from Members, pharmacy providers, physicians and internal staff; respond appropriately, referring calls to Clinical Pharmacist as necessary.
- Document and process third party prescription claims questions utilizing knowledge of on-line rejections and plan benefit and coverage rules.
- Document pharmacy case decisions that deviate from routine pharmacy management policies in designated health plan software package.
- Administer routine workflow for pharmacy coverage override requests, denials and appeals, as appropriate per Clinical Pharmacy policies and procedures.
- Prepare and distribute Member and provider communications in accordance with regulatory timeframes.
- Maintain pharmacy dashboard and trending report for pharmacy measures.
- Review reports as appropriate per Clinical Pharmacy policies and procedures to support vendor oversight.
- Provide support to Pharmacy Management staff on departmental audits of pharmacy vendor activity.
- Assist with and document quality assurance activities related to drug utilization.
- Provide general telephone and administrative support for the department.
- Demonstrate proficiency with the principles and methodologies of process improvement. Apply these in the execution of responsibilities in support of a process focused approach.
- Perform other duties as necessary or assigned.
- Associates Degree (or equivalent knowledge) is required. Additional related education and/or training is preferred. Pharmacy Technician Certification is preferred.
- Minimum two years of related experience in a pharmacy setting and/or managed care/pharmacy benefit environment.
- Comprehensive understanding of third party pharmacy benefits plan parameters.
- Excellent customer service skills.
- Demonstrate ability to communicate clearly, both verbally and in writing.
- Self-motivated with demonstrated ability to work independently and as member of a team
- Strong organizational, prioritization, communications and mathematics skills.
- Pharmacy claims processing computer System experience (preferred).
- Intermediate level proficiency with Microsoft Office applications.
17.41 - 21.58 /hourWhat is this?