Pharmacy Operations Support Specialist

🕒 May 15

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Lumeris

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS

Lumeris is a company focused on providing value-based care solutions within the healthcare industry. With over a decade of leadership in this field, Lumeris partners with health systems to improve patient outcomes and drive financial success through tech-enabled solutions. Their platform supports population health management, clinical delivery transformation, and payer contracting, offering comprehensive solutions for acute, post-acute, and high-risk patient management. Lumeris is recognized for creating significant cost savings and achieving excellent patient outcomes, including a 5-star CMS rating for its Medicare Advantage Prescription Drug Plan.

📋 Description

• Reviews rejected pharmacy claims for appropriateness. • Becomes a pharmacy claims processing subject matter expert and triages claims issues. • Becomes subject expert with Medicare Part D policies and procedures. • Reviews transition claims reports. • Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs. • Supports medical pharmacy prior authorizations and Medicare Part D drug reconsiderations. • Supports Medicare Part D call center questions and issues received from members, pharmacies, and providers. • Supports compliance functions and requests. • Supports quality programs including STARS. • Conducts retrospective claims reviews. • Complies, interprets, documents, and tracks findings from claims monitoring data.

🎯 Requirements

• High school diploma, GED, or equivalent • Current Certified Pharmacy Technician License in good standing • 1+ years Pharmacy Technician or retail pharmacy experience or the knowledge, skills, and abilities to succeed in the role • Flexible with the ability to consistently meet deadlines and adapt to a changing work environment • Strong planning, time management, and organizational skills • Team player with a positive attitude • Strong professional verbal and written communication skills • Basic PC skills, including Microsoft Excel, Word, and Outlook • Preferred 2+ years of experience in retail pharmacy • Preferred 2+ years of Pharmacy Technician experience • Part D health plan or pharmacy benefit management experience

🏖️ Benefits

• Medical, Vision and Dental Plans • Tax-Advantage Savings Accounts (FSA & HSA) • Life Insurance and Disability Insurance • Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) • Employee Assistance Program • 401k with company match • Employee Resource Groups • Employee Discount Program • Learning and Development Opportunities • And much more...