Pharmacy Coordinator Senior

Company : Highmark Inc.

Job Description :

JOB SUMMARY

This is a call center outreach position. This job provides front line staff guidance and ensures effective and efficient delivery of pharmacy call center services. The Pharmacy Coordinator is responsible for supporting Highmark Wholecare’s pharmacy programs with a focus on medication adherence and optimizing member health outcomes. This role involves a high volume of daily contacts with members, physicians, and pharmacies to address medication-related issues, promote adherence, and ensure appropriate medication utilization.

Work Schedule for this position is Monday/Wednesday/Friday 8:30 AM - 5:00 PM EST & Tuesday/Thursday 9:00 AM - 5:30 PM EST

ESSENTIAL RESPONSIBILITIES

• Communicate effectively with physicians and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner.
• Interact with staff to implement processes and effectively solve problems.
• Conduct outbound calls to members to discuss their medication regimens, identify barriers to adherence, and provide education and support.
• Contact physicians and pharmacists to clarify prescriptions, obtain prior authorizations, and discuss alternative therapies to improve medication adherence and reduce costs.
• Collaborate with internal teams, including pharmacists and case managers, to develop and implement strategies to improve medication adherence.
• Document all interactions and interventions accurately and completely in the appropriate systems.
• Monitor member medication adherence through claims data analysis and other available resources.
• Identify and resolve medication-related problems, such as potential drug interactions, adverse effects, and therapeutic duplications.
• Provide excellent customer service to members, physicians, and pharmacies.
• Maintain current knowledge of pharmacy practices, medications, and relevant healthcare regulations.
• Meet or exceed daily contact goals and quality standards.
• Contact physician network providers to obtain necessary and/or additional information when necessary.
• Consult clinical pharmacists for guidance and assistance as necessary.
• Identify and report improper coordination of benefit billing practices through paid claims review.
• Complete other assigned duties as specified.

QUALIFICATIONS

Minimum

• High school diploma or GED
• Experience in pharmacy prescription claims processing/submission/payment

Preferred

• Associate degree
• Pharmacy technician certification certificate
• Experience working in a managed care medication formulary management environment
• Working knowledge of retail pharmacy and/or third party prescription procession
• Strong background and understanding of medications and formulary terminology
• Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being familiar with applicable federal rules/regulations that remain consistent throughout the nation

Skills

• Excellent computer skills such as working knowledge of Microsoft Outlook, Word, OnBase
• Excellent interpersonal, communication and attentive listening skills
• Strong organizational skills, detail oriented
• Demonstrated excellence in communication skills
• Demonstrated ability to work well with others
• Demonstrated ability to work in a fast paced, multi-task environment

Position Type:

Remote/Work from Home

SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?

No

WORK ENVIRONMENT

Is Travel Required?
No

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice