Pharmacy Operations Specialist

2 weeks ago


Albuquerque, United States Health Care Service Corporation Full time
Job Summary

We are seeking a highly skilled Pharmacy Operations Representative to join our team at Health Care Service Corporation. As a Pharmacy Operations Representative, you will play a critical role in providing assistance to our customer service team, pharmacy coordinators, pharmacists, and members in resolving various pharmacy claims, pricing, and coding issues.

Key Responsibilities
  • Provide support to the customer service team, pharmacy coordinators, pharmacists, and members in resolving pharmacy claims, pricing, and coding issues.
  • Work with internal departments and external vendors to evaluate and resolve pharmacy-related issues.
  • Develop and maintain strong relationships with internal stakeholders, including customer service teams, PBMs, pharmacies, providers, and members.
  • Collaborate with cross-functional teams to resolve pharmacy-related gaps in care, coverage, and claims submission issues.
  • Utilize strong communication and problem-solving skills to resolve complex pharmacy-related issues.
Requirements
  • Valid Certified Pharmacy Technician (CPhT) certification.
  • Bachelor's degree in Business or a related healthcare field, or 4 years of work experience in a pharmacy/healthcare/managed care industry.
  • Verbal and written communication skills.
  • Proficiency in MS product suite, including Word, Excel, Access, and database software.
  • Drug information skills.
  • Ability to handle multiple tasks and strong organizational skills.
  • Managed care customer service experience.
Preferred Requirements
  • Retail/Hospital/Specialty Pharmacy, Pharmacy Benefits Manager, MCO, Health Plan pharmacy customer service experience.
  • Medicare/STARS, Facets knowledge or experience.
  • Inquisitive, continuous learning, critical thinking skills for understanding regulations, benefits, and ability to complete departmental projects.
  • Outbound telephone support to include members, providers, pharmacies, and PBM/vendor, program/campaign outreach.
  • Support through written and digital channels.


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