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Clinical Operations Specialist
2 months ago
About Us:
EmpiRx Health is a leading pharmacy benefits management company that prioritizes clinically-driven care. As a pioneer in value-based pharmacy care, we empower our customers and members to take control of their pharmacy benefits, healthcare outcomes, and financial results.
Our Mission:
We focus on delivering tailored strategies for our clients, leveraging our AI-powered pharmacy care platform, ClinicallyTM. Our pharmacists and clinicians work collaboratively to provide high-quality pharmacy care, enabling benefits plan sponsors to keep their members healthy, happy, and productive while reducing prescription drug spending.
Job Summary:
We are seeking a highly skilled and experienced Clinical Operations Specialist to join our team. In this critical role, you will ensure proficiency with the adjudication platform, understand claim processing, and provide clinical review support. You will work closely with our call center, clinical pharmacists, and other internal teams to deliver exceptional white-glove service to our clients and members.
Key Responsibilities:
- Provide account support to internal teams for adjudication, clinical review, and claims support-related matters.
- Ensure timely completion of day-to-day processes and assigned cases, adhering to standard operating procedures.
- Address escalation requests within a targeted 2-hour turnaround time.
- Manage claims override and prior authorization support, delivering exceptional service to clients and members.
- Act as a subject matter expert on the adjudication platform, demonstrating a keen understanding of claims support.
- Perform under the supervision of the ClinOps Manager and clinical pharmacists.
- Effectively communicate and interact with all other EmpiRx Health departments, fostering teamwork and unity.
Requirements:
- Minimum five years of pharmacy experience
- CPhT certification
- Minimum two years of claim adjudication experience
- Minimum two years of prior authorization experience
- Strong customer service orientation and commitment to delivering exceptional service.
- Ability to work in a fast-paced environment.
- Time management skills with the ability to meet tight deadlines.
- Excellent verbal and written communication skills
- Proficient in Microsoft Office Suite
- BS (Bachelor's) Preferred
- Two years of experience in PBM, health plan, or equivalent preferred
- Ability to work in office 5 days per week.
Why Work with Us:
- We are a collaborative team that encourages groundbreaking ideas, values open dialogue, and prioritizes continuous improvement.
- You will be part of a dynamic team where success is a shared celebration, collaboration fuels progress, and we redefine healthcare together.
- We offer a generous and competitive benefits package.
- You will share in the company's success through our discretionary bonus program.
