Admin/Clerical - Pharmacy Specialist Level 1 - Newark, NJ (Hybrid)
Title: Admin/Clerical - Pharmacy Specialist Level 1 Location: Newark, NJ (Hybrid) Duration: 3+ Months (Possible extension) Job Summary: This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects. Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies Responsibilities: Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria. - Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues. - Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing. - Process appeals complaints executive inquiries and compliance related issues. - Provide recommendations to increase efficiency, accuracy and productivity in the department. - Process ad hoc request for information or reports from stakeholders. - Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations. - Assist in the day to day business functions of the pharmacy department as well as the Medication Therapy Management program. - Provide support to various clinical programs within the pharmacy department. Education/Experience: - Prefers a Bachelor's degree from an accredited college or university in Health Care Management, Business or Pharmaceutical Administration. - Requires minimum of two (2) years experience in third party prescription program claim adjudication. - Requires minimum of two (2) years experience as a Pharmacy Utilization Management Specialist. - Requires prior customer service/service quality initiative experience. Regards, Abhishek Kumar Senior Recruiter [email protected] 732 351 4075 Apply tot his job Apply To this Job