Receive verbal and written requests for prior authorization from pharmacists, physicians and/or patients
Support and assist in the coordination of Pharmacy Services activities including generating correspondence and special projects
Process prior authorizations by reviewing documents for accuracy and completeness
Directly interact with members, physician office staff, pharmacies and internal stakeholders for eligibility and coverage determination
Job description
Our client, is a Health Insurance company, is looking for a Pharmacy Specialist Level 1 for their Remote location.
Responsibilities:
This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including generating correspondence and special projects.
Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies
Process prior authorizations received via prior authorization help line and fax application by reviewing the documents, evaluating for accuracy and completeness of the medical necessity forms for specific drugs based on provided criteria.
Submit clinical review and determination.
Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.
Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
Provide recommendations to increase efficiency, accuracy and productivity in the department.
Process and request for information or reports from stakeholders.
Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations.
Assist in the day-to-day business functions of the pharmacy department.
Provide support to various clinical programs within the pharmacy department.
Requirements:
National Pharmacy Certification preferred.
Requires minimum of two (2) years’ experience in third party prescription program claim adjudication.
Requires minimum of two (2) years’ experience as a Pharmacy Technician.
