Clinical Operations Coordinator

2 weeks ago

Orlando, Florida, United States EmpiRx Health Full time
Job Overview

About EmpiRx Health:
EmpiRx Health stands at the forefront of pharmacy benefits management, driven by clinical excellence. As a leader in value-based pharmacy care, we prioritize our customers and members, empowering them to manage their pharmacy benefits, healthcare outcomes, and financial implications effectively.

Our Mission:
We emphasize member care above all else, focusing on health outcomes as our primary goal. Our dedicated pharmacists and clinicians are integral to our operations, and our innovative population health solutions provide customized strategies for our clients. Through our advanced, AI-driven pharmacy care platform, ClinicallyTM, we deliver exceptional pharmacy care, ensuring that benefits plan sponsors can maintain the health, satisfaction, and productivity of their members while significantly curtailing the rising costs of prescription medications.

Position Summary:
We are currently seeking a proficient Clinical Operations Specialist to join our expanding team. In this pivotal position, you will be responsible for ensuring effective use of the adjudication platform, comprehending claim processing intricacies, and offering clinical review assistance. The Clinical Operations team plays a vital role in providing prompt support for overrides and clinical evaluations, ensuring that our members receive top-tier service. Collaboration with call center staff, clinical pharmacists, and other internal teams is essential.

Key Responsibilities:

  • Act as a primary support resource for internal teams regarding adjudication, clinical review, and claims-related inquiries.
  • Ensure the timely execution of daily operations and case assignments, adhering to established protocols.
  • Address escalation requests within a designated turnaround timeframe.
  • Manage claims overrides and prior authorization requests, delivering exceptional service to clients and members.
  • Serve as a subject matter expert on the adjudication platform, showcasing a thorough understanding of claims support processes.
  • 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:

  • A minimum of five years of experience in pharmacy.
  • CPhT certification is required.
  • At least two years of experience in claim adjudication.
  • A minimum of two years of experience in prior authorization.
  • Strong commitment to customer service and delivering high-quality support.
  • Ability to thrive in a fast-paced environment.
  • Excellent time management skills and ability to meet strict deadlines.
  • Outstanding verbal and written communication abilities.
  • Proficiency in Microsoft Office Suite.
  • A Bachelor's degree is preferred.
  • Two years of experience in a PBM, health plan, or similar environment is preferred.
  • Willingness to work in an office setting five days a week.

Why Choose EmpiRx Health:

  • Be part of a remarkable journey where innovation meets excellence.
  • Join a collaborative team that values creative ideas, open communication, and continuous improvement.
  • Experience a dynamic work environment where achievements are celebrated, teamwork drives progress, and we collectively redefine healthcare.
  • Benefit from a competitive and comprehensive benefits package.
  • Participate in the company's success through our discretionary bonus program.

EmpiRx Health is an Equal Opportunity Employer.
We are dedicated to fostering a diverse and inclusive workplace. Discrimination and harassment of any kind are strictly prohibited. All employment decisions are based on business needs, job requirements, and individual qualifications. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Your career at EmpiRx Health awaits – be part of shaping the future of healthcare excellence.

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