Pharmacy Operations Specialist

Pay Range: $20 per hour - $25 per hour

Summary:

• Reporting to the Manager of Pharmacy Operations
• Role involves supporting pharmacy utilization management programs, processing prior authorization requests, and providing customer service

Responsibilities:

• Receive, process, and review prior authorization requests through fax, phone, or electronic systems
• Apply clinical policy criteria to prior authorization requests
• Review and interpret member eligibility, claim history, and pharmacy program information using claims software
• Communicate determinations to members and providers via phone, fax, and letters
• Analyze and resolve issues related to formulary and benefits administration
• Provide pharmacy-related customer service
• Process pharmacy authorizations using real-time claims adjudication software
• Support new clinical program implementation
• Serve as a liaison to Member Services and other internal clients for real-time support on benefit interpretation
• Other responsibilities as needed

Requirements:

• Minimum of a High School diploma or equivalent required; Associate or Bachelor’s degree preferred
• Minimum two years of experience in a professional or pharmacy setting
• Excellent customer service skills
• Strong organizational, problem-solving, communication, and interpersonal skills
• Excellent written and oral communication skills
• Strong data entry skills and attention to detail
• Ability to multitask and be results-oriented

Preferred Skills:

• Experience in a managed care environment
• Prior customer service experience