Pharmacy Services Coordinator
2 weeks ago
Job Overview:
The Pharmacy Services Coordinator plays a crucial role in managing verbal and written requests for prior authorization from healthcare professionals and patients. This position is integral to the coordination of Pharmacy Services, which includes analyzing claim utilization, designing prescription plans, generating ad-hoc reports, and managing correspondence and special projects. Adherence to organizational goals and compliance with regulatory standards is essential.
Key Responsibilities:
- Evaluate prior authorization requests received through the help line, assessing the medical necessity and appropriateness of specific medications based on established medical criteria.
- Engage directly with members, physician office staff, pharmacies, and internal stakeholders to address eligibility, coverage determinations, and claims-related issues.
- Facilitate compliance with formulary and promote generic dispensing through effective communication with healthcare providers.
- Handle appeals, complaints, executive inquiries, and compliance-related matters efficiently.
- Offer insights and recommendations aimed at enhancing departmental efficiency, accuracy, and productivity.
- Respond to ad hoc requests for information or reports from various stakeholders.
- Participate in training sessions for clients, members, and employees to ensure a comprehensive understanding of pharmacy services programs and operations.
- Support daily operations within the pharmacy department and contribute to the Medication Therapy Management program.
- Assist with various clinical initiatives within the pharmacy department.
Qualifications:
A Bachelor's degree from an accredited institution in Health Care Management, Business, or Pharmaceutical Administration is preferred. Candidates should possess a minimum of two (2) years of experience in third-party prescription program claim adjudication and two (2) years as a Pharmacy Utilization Management Specialist. Prior experience in customer service or service quality initiatives is also required.
Work Environment:
This is a remote position with the possibility of occasional travel for meetings as necessary.
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