Pharmacy Benefits Coordinator

16 hours ago


Wheeling, West Virginia, United States The Health Plan of West Virginia Inc Full time
Job Summary

The Pharmacy Technician plays a vital role in ensuring the smooth operation of our pharmacy benefits program. As a key member of our team, you will be responsible for providing exceptional customer service, resolving member and provider inquiries, and working closely with pharmacists to review and process medication coverage requests.

Key Responsibilities
  1. Customer Service: Provide timely and accurate responses to member and provider inquiries, resolving issues and escalating complex cases to clinical pharmacists or medical directors as needed.
  2. Medication Coverage Requests: Review and process medication coverage requests, attaching relevant policy information and escalating requests to clinical pharmacists or medical directors for review.
  3. Claims Processing: Assist pharmacies in processing prescription claims, reviewing and troubleshooting claims for accuracy and adherence to contract guidelines.
  4. Communication: Provide verbal verification of member plan eligibility and applicable pharmacy benefits, and communicate decision to physician's office and/or members through verbal and/or written notification.
  5. Documentation: Accurately document coverage request outcomes, member and provider inquiries, and grievances in our pharmacy benefit manager's system and medical review system.
Requirements
  • Education: High School diploma or equivalent.
  • Certification: National Pharmacy Technician Certification.
  • Experience: One year experience in a retail, hospital, managed care, or other similar pharmacy setting.
  • Skills: Strong communication and problem-solving skills, with the ability to work effectively as part of a team and independently.
Preferred Qualifications
  • Education: Degree in a health-related field.
  • Experience: Experience performing medication authorizations in a pharmacy or managed care environment.


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