Pharmacy Services Specialist

2 weeks ago

Durham, United States Robert Half Full time
Job DescriptionJob DescriptionWe are seeking a Pharmacy Services Specialist based in Durham, North Carolina. This role involves non-clinical tasks related to pharmacy benefit management, with a focus on reviewing prescription pre-authorization requests. This role offers a long term contract employment opportunity in the healthcare industry, and it is a remote role, allowing you to work from the comfort of your home.

Responsibilities:

• Review and process online/fax requests for prescription pre-authorization, ensuring all necessary details are submitted correctly.
• Maintain a high level of accuracy in reviewing a minimum of 7 cases per hour, with the potential for handling up to about 14 cases hourly.
• Handle tasks related to operations of pharmacy benefit management, including the research, development, and implementation of related programs, projects, and initiatives.
• Coordinate the review, implementation, and quality assurance of benefit plan administration with internal stakeholders.
• Resolve or coordinate the resolution of escalated customer service inquiries and grievances related to pharmacy.
• Coordinate the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate.
• Handle the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as necessary.
• Respond to and coordinate the review and approval of RFPs, government program applications, and similar requests.
• Ensure a high quality of work, with all cases being audited for a Quality of 98 without error and maintaining strong production output.
• Use skills in Operations, Research, Quality, Review, Human Resources (HR) Administration, Internet, Benefit Functions, Hiring Processes, Production, and Implementation to fulfill the role's requirements.• Demonstrated experience in Pharmacy Services is necessary
• Proficiency in Operations, Research, and Quality Review
• Knowledge of Human Resources Administration and Hiring Processes
• Ability to navigate and utilize the Internet effectively
• Understanding of Benefit Functions and Financial Notes
• Experience in Production, Implementation, and Coordination
• Ability to communicate and collaborate with Stakeholders
• Familiarity with Clinical Trial Operations and Research Analysis
• Experience in working with Residents and making necessary Adjustments
• Knowledge of Quality Assurance and Authorizations processes
• Ability to handle Missing Invoices and Appeals
• Proficiency in Pharmacy, Prescription, Fax, and Contractual procedures
• Must have excellent verbal and written communication skills
• Ability to work independently and as part of a team
• Proficiency in relevant software and computer applications
• Strong problem-solving and decision-making abilities
• Exceptional attention to detail and organizational skills.

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