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Pharmacy Specialist I
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Job Description
- Req#: 2019-9823
Employer Industry: Health Insurance
Why consider this job opportunity:
- Salary up to $58,800
- Comprehensive health benefits (Medical/Dental/Vision)
- Generous PTO and paid volunteer time off
- Incentive plans and wellness programs
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
What to Expect (Job Responsibilities):
- Handle all telephonic interactions with members, physician office staff, pharmacies, and internal stakeholders regarding Pharmacy eligibility and coverage determinations
- Engage with physicians and pharmacists to facilitate formulary compliance and optimize generic dispensing
- Capture accurate clinical information for prior authorization requests to support medical necessity determinations
- Process complaints, appeals, grievances, and compliance-related issues
- Identify potential fraud, waste, and abuse through interactions with members and providers
What is Required (Qualifications):
- High School Diploma or GED required
- Minimum of two (2) years of experience as a Pharmacy Technician
- Requires prior customer service experience
- National Pharmacy Technician Certification (PTCB or ExCPT) required, or a minimum of 5 years of relevant pharmacy experience in managed care or a PBM organization
- Knowledge of third-party prescription program claim adjudication and common medical terminology
How to Stand Out (Preferred Qualifications):
- Minimum of two (2) years of experience in third-party prescription program claim adjudication preferred
- Familiarity with managed care principles and New Jersey Board of Pharmacy regulations
#HealthInsurance #PharmacyServices #CareerOpportunity #CompetitivePay #EmployeeBenefits
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