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Medication Management Specialist
2 months ago
We are currently seeking a Medication Management Specialist for a contract opportunity with one of our esteemed clients.
Position: Medication Management Specialist (Call Center/Help Desk)
Location: Remote/Hybrid (onsite as necessary)
Contract Duration: 6+ Months
Compensation: $18-20/hour
ROLE SUMMARY
Department: Pharmacy Help Desk
This role involves supporting healthcare providers (pharmacists and physicians) with inquiries related to Medicare Part D and/or Commercial pharmacy/specialty drug benefits, including drug coverage questions and prior authorization processes.
KEY RESPONSIBILITIES
- Efficiently manage incoming calls to provide necessary assistance to healthcare providers.
- Assist in triaging prior authorization requests under the guidance of a Clinical Pharmacist.
- Help maintain pharmacy prior authorization criteria utilized in the processing of pharmacy/specialty claims.
- Analyze written inquiries to facilitate the entry and updating of pharmacy authorizations within the claims system.
- Communicate coverage determination statuses to healthcare providers and/or members, implementing decisions within the authorization tool.
- Troubleshoot issues, inquiries, and new processing procedures related to coverage determinations.
- Support compliance with internal control systems and regulations.
- High School Diploma or GED required; two (2) years of college education preferred.
- A minimum of two (2) years of experience in retail or hospital pharmacy is required.
- Pharmacy Technician Certification (PTCB) is preferred.
- Familiarity with prescription drug names, therapeutic classes, and claims processing is essential.
- Experience with Medicare Part D prescription benefits may be advantageous for certain roles.
- In-depth knowledge of pharmacy claims processing.
- Understanding of formularies and utilization management edits.
- Familiarity with pharmaceutical manufacturers and product/cost information.
- Proficient in Microsoft Office and other computer applications.
At S3, our mission is to foster trusting relationships and deliver solutions that positively impact our clients, consultants, and communities. Our core values include:
- Setting high standards for corporate responsibility.
- Creating job opportunities.
- Providing individuals with the chance to succeed and improve their circumstances.
- Enhancing the communities where we operate through volunteerism and charitable contributions.
As an employee of S3, you will be eligible for a comprehensive benefits package that may include:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Plan
- Paid Time Off
- Life & Disability Insurance Plans
- Flexible Spending Accounts
- Tuition Reimbursement
