Job Description
Our Client, a Medical Center company, is looking for a Pharmacy Operations Specialist for their Charlestown, MA location.
Responsibilities:
Requirements:
Why Should You Apply?
Responsibilities:
- Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements.
- Properly apply clinical policy criteria to the review of prior authorization requests
- Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email
- Interprets medical and pharmacy data and accurately enters information into system according to regulatory and NCQA accreditation requirements
- Communicate determinations to members and providers via incoming and outgoing telephone calls, fax notifications, and letter notifications
- Responsible for analysis and issue resolution as it pertains to the administration of the formulary and benefits
- Provide pharmacy-related customer service to both internal and external parties.
- Process pharmacy authorizations utilizing PBM real time online claims adjudication software.
- Support new clinical program implementation
- Serve as a liaison to Member Services and other internal clients for real-time support on pharmacy benefit interpretation, Pharmacy Policy interpretation, and plan design interpretation.
- Other responsibilities as needed
- Supervision Received:
- General supervision received daily
Requirements:
- Minimum of a High School diploma or equivalent required.
- Associate or bachelor’s degree preferred
- Experience:
- Two or more years of experience in a professional or pharmacy setting
- Previous experience in a managed care environment preferred
- Prior customer service experience preferred
- Competencies, Skills, and Attributes:
- Excellent Customer Service skills
- Prior experience assisting members and/or providers with telephone inquiries
- Strong organizational, problem solving, communication, and interpersonal skills
- Excellent written and oral communication skills required.
- Must have strong data entry and attention to detail in building cases
- Must be able to multitask and be results oriented
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
Numbers & Facts
| Location | Charlestown, MA |
| Industry | Management Consulting Services |
| Salary | $16.47–$20.63 Per Hour |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | https://www.iconma.com/ |
Benefits
401K, Employee Referral Program, Life Insurance
About Company
ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.
- Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
- Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
- Founded in 2000
- 2000+ Employees
The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.
Skills
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