Motion Recruitment Partners is Hiring a Pharmacy Services Specialist Near Durham, NC
Job Details
Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Pharmacy Services Specialist. They have over 4 million customers and 5,000 employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.
Location: ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
Contract Duration: 6 Months
Required Skills & Experience
High school diploma or GED
3 years of experience in related field.
Pharmacy Experience
What You Will Be Doing Daily Responsibilities
Provides daily coordination of activities related to operations of pharmacy benefit management.
Provides support to staff and coordinates tasks regarding the research, development, implementation and evaluation of programs, projects and initiatives.
Serves as resource to staff and subject matter expert for assigned initiatives to provide input regarding pharmacy needs, impacts and projects.
Resolves issues and escalates to management as appropriate; assists management in addressing clinical and contractual issues.
Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team.
Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing/making pharmacy claim adjustments as appropriate.
Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate
Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate.
Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.
****To be eligible to contract at this client you must be able to pass a drug test and criminal background check