Senior Pharmacy Coordinator

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🔥 1 minute ago

🏈 Alabama, Alaska, +46 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote 🍑 Georgia – Remote

💵 $19 - $27 / hour

⏰ Full Time

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Provide front-line staff guidance and ensure effective, efficient delivery of Pharmacy call center services • Serve as first-line reviewer for adherence to state and federal drug benefit designs • Respond to physician and pharmacy network provider inquiries regarding oral, injectable, and infusion medication requests, drug claim edits, and prior authorizations • Review member claims history and define medical necessity for non-formulary and prior authorization medication exception requests • Educate and assist pharmacy network providers with denied point-of-sale prescription claims and coordination of benefits procedures • Communicate with providers to address provider and plan member needs • Interact with staff to implement processes and solve problems • Evaluate and direct daily departmental workflow • Prioritize drug authorization and denial requests • Review prior authorization criteria for drug products • Recommend staffing adjustments to maintain efficiency and productivity • Ensure compliance with call center turnaround requirements associated with DPW/CMS regulations • Evaluate non-formulary drug exception requests before approval, authorization, or claim override • Search member claim histories and recommend formulary alternatives • Contact physician network providers to obtain additional information • Consult clinical pharmacists as needed • Document authorizations and denials accurately and within regulatory timelines • Populate authorization and denial fields in OnBase • Enter authorizations into Argus IPNS for claim adjudication • Identify and report improper coordination-of-benefits billing practices through paid-claims review • Participate as pharmacy representative in onsite member appeals and grievance sessions • Serve as a technical staff resource • Complete other assigned duties

🎯 Requirements

• High school diploma or GED • Experience in pharmacy prescription claims processing/submission/payment • Associate degree (preferred) • Pharmacy technician certification certificate (preferred) • Experience working in a managed care medication formulary management environment (preferred) • Working knowledge of retail pharmacy and/or third party prescription processing (preferred) • Strong background and understanding of medications and formulary terminology (preferred) • Familiarity with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states • Familiarity with Medicare drug benefit design offerings and applicable federal rules/regulations • Excellent computer skills, including Microsoft Outlook, Word, and OnBase • Excellent interpersonal, communication, and attentive listening skills • Strong organizational skills and attention to detail • Ability to work well with others • Ability to work in a fast-paced, multi-task environment • Compliance with HIPAA, data security guidelines, company policies, applicable laws, rules, and regulations

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