What are the responsibilities and job description for the Pharmacy Benefit Specialist position at Palmetto Infusion?
About Us:
Palmetto Infusion provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments. We strive for more than personal service – always delivering a warm and attentive health care experience that boosts patients’ state-of-mind, improves their health, and quality of life.
At Palmetto Infusion, we believe in creating an experience that goes beyond just a job. It's about being part of something bigger than yourself - a connected group of caretakers who work together to restore health and hope to our patients. We call it The Palmetto Experience, and we believe it's what sets us apart from other employers.
For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities.
About the Role:
The Pharmacy Benefit Specialist will serve as the primary escalation point for all pharmacy benefit-related issues. This role is critical in supporting intake processes, resolving complex claim issues, and developing strategic solutions to address root causes.
Minimum Qualifications:
Experience/Education:
At Palmetto Infusion, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount. We understand that every interaction, every decision, and every effort contribute to the quality of care our patients receive.
Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates "The Palmetto Experience" — a standard of excellence that defines us and enriches the lives of those we serve.
Physical Demands:
All employees must uphold the confidentiality of protected health information and follow all HIPAA policies. This position has access to sensitive information and a breach of information may be grounds for immediate termination.
We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Palmetto Infusion provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments. We strive for more than personal service – always delivering a warm and attentive health care experience that boosts patients’ state-of-mind, improves their health, and quality of life.
At Palmetto Infusion, we believe in creating an experience that goes beyond just a job. It's about being part of something bigger than yourself - a connected group of caretakers who work together to restore health and hope to our patients. We call it The Palmetto Experience, and we believe it's what sets us apart from other employers.
For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities.
About the Role:
The Pharmacy Benefit Specialist will serve as the primary escalation point for all pharmacy benefit-related issues. This role is critical in supporting intake processes, resolving complex claim issues, and developing strategic solutions to address root causes.
Minimum Qualifications:
Experience/Education:
- Pharmacy Technician Certification required
- 2 years of experience related to pharmacy benefits and prior authorization processes, strong understanding of pharmacy benefit management and claims processing.
- Proficient at partner programs (i.e.: MS Outlook, Word, Excel).
- Ability to cope with ambiguous, changing environment while under pressure in a calm manner.
- Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion.
- Act as the escalation point for all pharmacy benefit-related concerns, including handling calls from patient services and pharmacy teams regarding claim issues.
- Run test claims during the intake process to proactively identify potential issues.
- Advocate for prior authorization approvals and assist with challenging cases.
- Monitor pending referrals to identify opportunities for intake process improvements.
- Provide oversight of pharmacy claims processing, including monthly reporting to identify trends and areas for improvement.
- Develop and maintain job aids and training materials to support ongoing education efforts within the team.
- Audit PBM prior authorization request submissions to ensure accuracy, compliance, and timeliness.
- Provide expert support to address and resolve claim rejections efficiently.
- Collaborate with cross-functional teams to build and refine a decision tree, determining when claims should be billed through pharmacy benefits versus medical benefits.
- Offer input related to PBM settings within claims systems to optimize workflows and maximize efficiency.
- Competitive Compensation
- Comprehensive Medical Insurance
- Dental and Vision Insurance
- Company Life Insurance
- Voluntary Life and Disability Insurance
- Additional Voluntary Supplemental Plans
- Flexible Spending Account (Medical and Dependent Care)
- Health Savings Account
- 401K Retirement Plan
- Employee Assistance Program (EAP)
- Employee Discounts
- Ramsey SmartDollar Program
- Referral Program
- Tuition Assistance
- Paid Time Off
- 8 Paid Company Holidays
At Palmetto Infusion, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount. We understand that every interaction, every decision, and every effort contribute to the quality of care our patients receive.
Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates "The Palmetto Experience" — a standard of excellence that defines us and enriches the lives of those we serve.
Physical Demands:
- The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk, and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors, and staff.
All employees must uphold the confidentiality of protected health information and follow all HIPAA policies. This position has access to sensitive information and a breach of information may be grounds for immediate termination.
We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
