[Hiring] Specialty Rx Coordinator @Allied Benefit Systems

Role Description

This 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 Functions

• Collect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacity
• Arrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member’s associated QicLink page
• Execute, manage, and provide on-going support of single case agreements
• Assist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendors
• Submit member referrals to third-party vendors managing specialty carve-out programs
• Serves as liaison for external vendors when implementing specialty carve-out programs
• Reviews current and newly requested vendor plan language to understand impact with governmental regulations
• Ensure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycle
• Collaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendor
• Management of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teams
• Other duties as assigned

Qualifications

• Bachelor’s degree or equivalent work experience required
• At 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

Physical Demands

This is a standard desk role requiring extended sitting and computer work.

Work Environment

Remote

Benefits

• Medical, Dental, Vision, Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend