Pharmacy Operations Support Specialist

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

📋 Description

• Evaluates rejected pharmacy claims for their appropriateness.

• Serves as a subject matter expert in pharmacy claims processing and addresses claims-related issues.

• Gains expertise in Medicare Part D policies and procedures.

• Analyzes transition claims reports.

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

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

• Addresses questions and issues from members, pharmacies, and providers related to the Medicare Part D call center.

• Aids compliance functions and handles requests.

• Contributes to quality programs, including STARS.

• Performs retrospective claims reviews.

• Records, interprets, documents, and monitors findings from claims data analysis.

⛳️ Requirements

• High school diploma, GED, or equivalent qualification.

• Current Certified Pharmacy Technician License in good standing.

• At least 1 year of experience as a Pharmacy Technician or in a retail pharmacy, or possess the necessary knowledge, skills, and abilities for the role.

• Adaptable and consistently meets deadlines in a dynamic work environment.

• Strong planning, time management, and organizational abilities.

• Team-oriented with a positive demeanor.

• Excellent professional verbal and written communication skills.

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

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

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

• Experience in Part D health plans or pharmacy benefit management is preferred.

🏝️ 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...