Systemart, LLC · 2 days ago
Pharmacy Operations Specialist
United States
Contract
Remote
Entry, Mid Level
$32/hr - $34/hr
2+ years expSystemart, LLC is seeking a Pharmacy Operations Specialist who will support pharmacy utilization management programs and provide pharmacy-related customer service. The role involves processing prior authorization requests and assisting with the day-to-day operations of the pharmacy program.
Staffing Agency
Responsibilities
Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements
Properly apply clinical policy criteria to the review of prior authorization requests
Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email
Interprets medical and pharmacy data and accurately enters information into system according to regulatory and NCQA accreditation requirements
Communicate determinations to members and providers via incoming and outgoing telephone calls, fax notifications, and letter notifications
Responsible for analysis and issue resolution as it pertains to the administration of the formulary and benefits
Provide pharmacy-related customer service to both internal and external parties
Process pharmacy authorizations utilizing PBM real time online claims adjudication software
Support new clinical program implementation
Serve as a liaison to Member Services and other internal clients for real-time support on pharmacy benefit interpretation, Pharmacy Policy interpretation, and plan design interpretation
Other responsibilities as needed
Qualification
Required
Minimum of a High School diploma or equivalent required
Two or more years of experience in a professional or pharmacy setting
Excellent Customer Service skills
Prior experience assisting members and/or providers with telephone inquiries
Strong organizational, problem solving, communication, and interpersonal skills
Excellent written and oral communication skills required
Must have strong data entry and attention to detail in building cases
Must be able to multitask and be results oriented
Preferred
Associate or Bachelor's degree preferred
Previous experience in a managed care environment preferred
Prior customer service experience preferred
Company
Systemart, LLC
For over 15 years we have been providing staffing services to customers nationwide. We are a certified MBE company based out of New Jersey.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Jayshree Dabhi
HR Business Partner
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