Pharmacy Coordinator

Pharmacy Coordinator

The 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 Qualifications

• High School Diploma/GED
• 3-5 years of Customer Service experience
• Pharmacy Experience
• Pharmaceutical Knowledge
• Pharmacy Benefits Management Understanding
• Barrier Identification & Problem Solving
• Proficient in Microsoft Suite

Preferred Qualifications

• 1-3 Healthcare Insurance Experience Strongly Preferred
• Bilingual Spanish speaker