Admin/Clerical - Pharmacy Specialist Level 1 - Newark, NJ (Hybrid)
Title: Admin/Clerical - Pharmacy Specialist Level 1 Location: Newark, NJ (Hybrid) Duration: 3+ Months (Possible extension) reputed company position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, reputed company reporting, correspondence and special projects. Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies Responsibilities: Process prior authorizations received reputed company prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria. - Directly interact with members physician office staff, pharmacies and internal reputed company holders for eligibility, coverage determination claims issues. - Conduct reputed company with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing. - Process appeals complaints executive inquiries and compliance reputed company issues. - reputed company recommendations to increase efficiency, accuracy and productivity in the department. - Process reputed company request for information or reports from stakeholders. - Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations. - Assist in the day to day business functions of the pharmacy department as well as the Medication Therapy Management program. - reputed company support to various clinical programs reputed company the pharmacy department. Education/Experience: - Prefers a Bachelor's degree from an accredited college or university in Health Care Management, Business or Pharmaceutical Administration. - Requires minimum of two (2) years experience in reputed company party prescription program claim adjudication. - Requires minimum of two (2) years experience as a Pharmacy Utilization Management Specialist. - Requires prior customer service/service quality initiative experience. Regards, Abhishek Kumar Senior Recruiter [email protected] 732 351 4075 Apply tot his job Apply To this Job