Position Location: Pittsburgh PA, 444 Liberty Avenue
Responsibilities and Duties:
The Pharmacy Coordinator provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. This position responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Will interact with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.
1. Communicate effectively with physician and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner. Interact with staff to implement processes and problem solves.
2. Respond to drug benefit design inquires or exception requests and evaluate/direct daily workflow within the department to include but not limited to:
a. Prioritization of requests for drug authorizations or denials.
b. Review of prior authorization criteria for drug products
c. Recommend staffing adjustments necessary to appropriately maintain a level of high efficiency/productivity
d. Ensure call center turnaround time requirements associated with DPW/CMS regulations are adhered to
3. Complete other assigned duties as specified
a. Identify and report improper coordination of benefit billing practices through paid clams review
b. Participate as pharmacy representative in onsite member appeals and grievances sessions
4. Outreach to members to discuss adherence to medication
5. Serve as a resource for technical staff
6. Other duties as assigned or requested.
Must know some medical terminology
· Years of industry experience: 1 year of retail hospital experience
· Experience in pharmacy prescription claims processing/submission/payment.
· Educational requirements: High School Diploma/GED
· Experience working in a managed care medication formulary management environment
· Working knowledge of retail pharmacy and/or third party prescription procession
· Strong background and understanding of medications and formulary terminology
· Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being familiar with applicable federal rules/regulations that remain consistent throughout the nation.
· Excellent computer skills such as working knowledge of Microsoft Outlook, Word
· Excellent interpersonal, communication and attentive listening skills
· Strong organizational skills, detail oriented
· Demonstrated excellence in communication skills
· Demonstrated ability to work well with others
· Demonstrated ability to work in a fast paced, multi-task environment
Additional Salary Information: 15.00 ph
Internal Number: gat
Murtech Consulting is women owned staffing solutions organization that specializes in information technology, engineering, emerging technologies, infrastructure and customer support. We currently support clients throughout the country and strive to become the premier “problem solver” for our clients staffing challenges.
Murtech Consulting has 3 simple core values: integrity, passion and work ethic. Our value proposition and services are built on servicing our employees and clients with these core values.
Why Murtech…because we help identify our clients’ challenges and identify and propose effective solutions. Murtech focuses on the IT and Engineering staffing and placement space to ensure that our efforts are managed to the clients’ full expectations.
Forming a collaborative partnership with our clients and understanding their unique requirements is at the essence of our value proposition and Core Values. Before we can effectively react and respond to your open positions, we drill in and engage with you, our client. We ask questions, understand your needs and determine the best staffing solutions to meet and exceed expectations. Our reward i...s in having long-term client relationships, allowing our teams to focus on delivering the highest quality possible—every time.