Pharmacy Operations Support Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluates rejected pharmacy claims for their validity.

• Develops expertise in pharmacy claims processing and addresses claims-related issues.

• Gains in-depth knowledge of Medicare Part D policies and procedures.

• Analyzes transition claims reports.

• Collaborates with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure timely access to prescription medications.

• Assists with medical pharmacy prior authorizations and Medicare Part D drug reconsiderations.

• Addresses Medicare Part D call center inquiries and issues from members, pharmacies, and providers.

• Aids compliance functions and responds to requests.

• Contributes to quality programs, including STARS.

• Performs retrospective claims reviews.

• Collects, interprets, documents, and monitors findings from claims tracking data.

⛳️ Requirements

• High school diploma, GED, or equivalent qualification.

• Valid Certified Pharmacy Technician License in good standing.

• Over 1 year of experience as a Pharmacy Technician or in retail pharmacy, or possesses the necessary knowledge, skills, and abilities to excel in this role.

• Adaptable and capable of consistently meeting deadlines in a dynamic work environment.

• Strong skills in planning, time management, and organization.

• A team-oriented individual with a positive demeanor.

• Excellent verbal and written communication skills in a professional setting.

• Basic computer proficiency, including Microsoft Excel, Word, and Outlook.

• Preferred: Over 2 years of experience in retail pharmacy.

• Preferred: Over 2 years of experience as a Pharmacy Technician.

• Experience with Part D health plans or pharmacy benefit management is a plus.

🏝️ Benefits

• Medical, Vision, and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...