Pharmacy Operations Support Specialist
About The Position
Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Pharmacy Operations Support Specialist Position Summary: Performs duties in one or more of the following areas: Medicare Part D rejected claims management, pharmacy prior authorizations, and assist Medicare Part D Customer Service call center team members.
Requirements
- High school diploma, GED, or equivalent
- Current Certified Pharmacy Technician License in good standing
- 1+ years Pharmacy Technician or retail pharmacy experience or the knowledge, skills, and abilities to succeed in the role
- Flexible with the ability to consistently meet deadlines and adapt to a changing work environment
- Strong planning, time management, and organizational skills
- Team player with a positive attitude
- Strong professional verbal and written communication skills
- Basic PC skills, including Microsoft Excel, Word, and Outlook
Nice To Haves
- 2+ years of experience in retail pharmacy
- 2+ years of Pharmacy Technician experience
- Part D health plan or pharmacy benefit management experience
- Certified Pharmacy Technician License
Responsibilities
- Reviews rejected pharmacy claims for appropriateness.
- Becomes a pharmacy claim processing subject matter expert and triages claims issues.
- Assist with resolution of rejected pharmacy claims via provider and/or pharmacy outreach.
- Compiles, interprets, documents, and tracks findings from pharmacy claims monitoring data.
- Becomes subject expert with Medicare Part D policies and procedures.
- Reviews Part D transition claims reports.
- Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs.
- Supports medical pharmacy prior authorizations (Part B).
- Supports Medicare Part D Customer Service call center questions and issues received from members, pharmacies, and providers.
- Supports compliance functions and requests, including support of the pharmacy department during CMS (Centers for Medicare and Medicare Services) audits when applicable.
- Supports quality programs including STARS.
- Conducts retrospective claims reviews.
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...
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
