[Hiring] Pharmacy Coordinator Senior @Highmark Health

Role Description

This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. Clearly defines the medical necessity of non-formulary and prior authorization medication exception requests, by reviewing member claims history. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.

Work Schedule for this position is Monday/Wednesday/Friday 8:30 AM - 5:00 PM EST & Tuesday/Thursday 9:00 AM - 5:30 PM EST.

Qualifications

• Minimum: High school diploma or GED
• Experience in pharmacy prescription claims processing/submission/payment
• Preferred: Associate degree
• Pharmacy technician certification certificate
• Experience working in a managed care medication formulary management environment
• Working knowledge of retail pharmacy and/or third party prescription processing
• Strong background and understanding of medications and formulary terminology
• Familiarity with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states
• Familiarity with Medicare drug benefit design offerings that may differ by state
• Familiarity with applicable federal rules/regulations that remain consistent throughout the nation

Requirements

• Excellent computer skills such as working knowledge of Microsoft Outlook, Word, OnBase
• Excellent interpersonal, communication and attentive listening skills
• Strong organizational skills, detail oriented
• Demonstrated excellence in communication skills
• Demonstrated ability to work well with others
• Demonstrated ability to work in a fast paced, multi-task environment

Benefits

• Remote/Work from Home

Company Description

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.