Pharmacy Coordinator

Pharmacy CoordinatorThe Pharmacy Coordinator provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. This position responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Will interact with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.Required QualificationsHigh School Diploma/GED3-5 years of Customer Service experiencePharmacy ExperiencePharmaceutical KnowledgePharmacy Benefits Management UnderstandingBarrier Identification & Problem SolvingProficient in Microsoft SuitePreferred Qualifications1-3 Healthcare Insurance Experience Strongly PreferredBilingual Spanish speakerAdditional DetailsContract only but there could be a possibility of full-time hire if a position becomes availableMust complete the Pharmacy Coordinator Assessment