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Allied Benefit Systems · 18 hours ago

Specialty Rx Administrator

United States

Full-time

Remote

Senior Level

$48K/yr - $55K/yr

5+ years exp

Allied Benefit Systems is a company focused on managing pharmacy benefits, and they are seeking a Specialty Rx Administrator. This role acts as a liaison between retail and specialty pharmacies and prescribers, managing prior authorization requests and assisting members with financial concerns regarding their medications.

Health CareInsuranceWellness

Responsibilities

Collect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacity

Arrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member’s associated QicLink page

Execute, manage, and provide on-going support of single case agreements

Assist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendors

Submit member referrals to third-party vendors managing specialty carve-out programs

Serves as liaison for external vendors when implementing specialty carve-out programs

Reviews current and newly requested vendor plan language to understand impact with governmental regulations

Ensure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycle

Collaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendor

Management of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teams

Other duties as assigned

Qualification

Prior authorization experiencePharmacyMedical benefitsSpecialty medications knowledgeAnalytical skillsMicrosoft Office SuitePrioritize tasksCommunication skillsOrganizational skillsTime management skillsProblem-solving skills

Required

Bachelor's degree or equivalent work experience required

At least 5 years of professional experience including comprehension of pharmacy and medical benefits, specialty medications, j-codes and their administration, limited distribution drugs as well as specialty pharmaceutical manager selection required

Prior authorization experience required

Excellent verbal and written communication skills

Excellent organizational skills and attention to detail

Excellent time management skills with a proven ability to meet deadlines

Strong analytical and problem-solving skills

Ability to prioritize tasks and to delegate them when appropriate

Ability to function well in a high-paced and at times stressful environment

Proficient with Microsoft Office Suite or related software