Pharmacy Operations Specialist
2 weeks ago
We are seeking a highly skilled Pharmacy Operations Consultant to join our team at Blue Cross Blue Shield companies. This role will be responsible for overseeing the accurate and timely resolution of member inquiries, identifying performance and compliance risks, and implementing corrective action strategies as needed.
Key Responsibilities- Oversee accurate and timely resolution of member inquiries, including but not limited to CMS, OPM, internal and external sources.
- Identify performance and compliance risks and communicate to leadership timely to minimize non-compliance.
- Review and track weekly, monthly, and quarterly reporting to identify any issues and implement corrective action strategies as needed.
- Assist with managing, tracking and approvals for communication requests, system updates, benefit changes in compliance with CMS and FEP requirements/standards.
- Support and interact with internal and external stakeholders to provide timely resolution to inquiries and issues.
- Foster collaborative relationships with internal and external stakeholders and vendor account teams.
- Implement new programs to increase the value of our services, including planning, implementation, data analysis, communications, and outcome management.
- Review trends and industry information to determine best practices, operational efficiencies, or process improvements to enhance program performance and the member experience.
- Bachelor's degree in Pharmacy, Business, Accounting, Management, Health Services, Information Systems or equivalent work experience.
- Minimum of three years of experience within a business environment services delivery setting, with experience in project management, and/or healthcare informatics.
- Technical proficiency with Microsoft Office, Teams and SharePoint.
- Experience in project management and/or account management.
- Experience setting priorities and meeting objectives for projects with multiple stakeholders.
We offer a comprehensive package of benefits, including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
This job is also eligible for annual bonus incentive pay.
No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable.
The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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