Pharmacy Coordinator

Highmark Health

Base: $19.39 - $24.19; bonus/equity: not specified...
Onsite
Experience in pharmacy prescription claims processing
Knowledge of medicaid and medicare drug benefit designs
Understanding of federal and state pharmacy regulations
This role serves as the first line reviewer ensuring adherence to health plan drug benefit offerings and federal regulations

Job Summary

  • This role serves as the first line reviewer ensuring adherence to health plan drug benefit offerings and federal regulations.
  • The incumbent is responsible for responding to physician inquiries regarding medication requests, claim edits, and prior authorizations.
  • Employees must document all authorizations and denials accurately within specific information systems to ensure timely notification.

Matching Summary

This role serves as the first line reviewer ensuring adherence to health plan drug benefit offerings and federal regulations.

Salary

Base: $19.39 - $24.19; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Experience in pharmacy prescription claims processing
  • Knowledge of Medicaid and Medicare drug benefit designs
  • Understanding of federal and state pharmacy regulations
  • Proficiency with OnBase and Argus IPNS systems
  • Ability to evaluate medical necessity for non-formulary drugs

Nice-to-have

  • Associate degree in a related field
  • Pharmacy technician certification
  • Experience in managed care formulary management
  • Strong interpersonal and communication skills
  • Ability to work in a fast-paced multi-task environment

Key Requirements

  • Minimum High school diploma or GED
  • Experience in pharmacy prescription claims processing
  • Pharmacy technician certification (Preferred)
  • Working knowledge of retail pharmacy processes

Work Rights

Not specified

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