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Pharmacy Operations Coordinator

Cambia Health Solutions

Bellevue, WA

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JOB DETAILS
JOB TYPE
Full-time, Employee
SKILLS
Analysis Skills, Artificial Intelligence (AI), Clinical Practices/Protocols, Communication Skills, Compensation and Benefits, Cross-Functional, Documentation, Establish Priorities, Federal Laws and Regulations, Health Economics, Health Insurance, Healthcare, Identify Issues, Leadership, Maintain Compliance, Managed Care, Microsoft Office, Multitasking, Negotiation Skills, Operational Support, Operations, Operations Processes, Organizational Skills, Patient Care Authorizations, Pharmacy, Prescription Drugs, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Project Development, Project/Program Management, Regulations, Regulatory Compliance, Regulatory Requirements, State Government, State Laws and Regulations, Systems Maintenance, Team Player, Time Management, Work From Home, Writing Skills
LOCATION
Bellevue, WA
POSTED
30+ days ago
Pharmacy Operations Coordinator

Work from home Within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated Pharmacy Operations Coordinator, are living our mission to make healthcare easier and lives better. As a member of Pharmacy Operations Team, our Pharmacy Operations Coordinator is responsible for coordinating operational and cross-functional teams to deliver initiatives that optimize prior authorization (PA) operations through enhanced efficiency, regulatory compliance, training, and quality improvements, all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

* Bachelor's degree required

* Minimum of 3 years of experience in the healthcare industry

* Experience must include focus in one or more of the following areas: Pharmacy operations, Prescription drug benefit administration, and/or Compliance functions

* Equivalent combination of education and experience will be considered

Skills and Attributes:

* Experience with health insurance, managed care, prior authorization (PA) processing, and/or prescription benefits, with a broad understanding of the processes and procedures for all areas within the Pharmacy Operations Team

* Broad understanding and knowledge of state and federal rules and regulations, with leadership skills and the ability to direct activities of others both individually and within a project team setting

* Ability to coordinate activities with all levels of staff and external partners through clear and concise verbal and written communication skills, while organizing, planning, prioritizing, and developing multiple projects within time constraints

* Ability to negotiate and resolve project and team issues with diplomacy and influence, with experience in applying process improvement methodology to a project or process

* Strong analytical and conceptual skills to identify complex business problems, develop comprehensive solutions, and implement effective courses of action with strong problem-solving abilities

* Proficiency in using MS Office products and other corporate software as required to support daily operations and project management

* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

* Demonstrate strong knowledge of clinical protocols, operational procedures, and systems used to support day-to-day prior authorization (PA), appeals, and related workflows, while serving as the key liaison within the PA team to ensure seamless implementation of process changes, system enhancements, and regulatory initiatives

* Support operational and regulatory requirements and initiatives by coordinating cross-departmental implementation to ensure accurate and compliant PA, appeal, and related processes across the organization

* Lead and/or contribute to preparations for compliance audits, accreditation documentation, government audits, and state audits to maintain organizational standards and regulatory compliance

* Coordinate with stakeholders to ensure new processes, procedures, regulations, and initiatives are clearly communicated, documented, and implemented in a timely and accurate manner across all affected teams

* Interact, coordinate, and communicate with all levels of management including but not limited to providers, stakeholders, and vendors to ensure effective and compliant use of systems a
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About the Company

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Cambia Health Solutions

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