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Clinical Operations Coordinator
2 months ago
About EmpiRx Health:
EmpiRx Health stands at the forefront of pharmacy benefits management, dedicated to a clinically-driven approach. As innovators in value-based pharmacy care, we prioritize our customers and members, empowering them to manage their pharmacy benefits, health outcomes, and financial implications effectively.
Our Mission:
We emphasize member care above all, focusing on health outcomes as our primary goal. Our team of pharmacists and clinicians is integral to our operations, delivering customized strategies through our advanced population health solutions.
Role Summary:
We are in search of a proficient Clinical Operations Specialist to support our expanding operations. This pivotal position involves mastering the adjudication platform, understanding claims processing, and providing essential clinical review assistance. The Clinical Operations team collaborates closely with call center staff, clinical pharmacists, and various internal teams to ensure exceptional service delivery.
Key Responsibilities:
- Act as a support liaison for internal teams regarding adjudication, clinical review, and claims support.
- Ensure timely execution of daily processes and assigned cases, following established operating procedures.
- Handle escalation requests efficiently, aiming for a 2-hour response time.
- Oversee claims overrides and prior authorization processes, ensuring high-quality service for clients and members.
- Serve as a subject matter expert on the adjudication platform, showcasing expertise in claims support.
- Work under the guidance of the Clinical Operations Manager and clinical pharmacists.
- Communicate effectively with all departments within EmpiRx Health, promoting teamwork and collaboration.
Qualifications:
- At least five years of experience in pharmacy.
- CPhT certification is required.
- A minimum of two years in claims adjudication.
- Two years of experience in prior authorization processes.
- Strong focus on customer service and commitment to delivering exceptional service.
- Ability to thrive in a fast-paced environment.
- Excellent time management skills to meet tight deadlines.
- Outstanding verbal and written communication abilities.
- Proficiency in Microsoft Office Suite.
- A Bachelor's degree is preferred.
- Two years of experience in pharmacy benefit management or health plans is advantageous.
- Willingness to work in an office setting five days a week.
Why Choose EmpiRx Health:
- Be part of a company that values innovation and excellence.
- Join a collaborative team that encourages creative ideas and continuous improvement.
- Experience a workplace where success is celebrated collectively, and teamwork drives progress.
- Enjoy a competitive benefits package.
- Participate in the company's success through a discretionary bonus program.
EmpiRx Health is an Equal Opportunity Employer.
We are committed to fostering a diverse and inclusive environment for all employees, prohibiting discrimination and harassment of any kind. All employment decisions are based on business needs, job requirements, and individual qualifications. We celebrate diversity and promote equality of opportunity for all.
