Pharmacy Coordinator Senior
Core
Senior Pharmacy Coordinator providing front-line guidance for pharmacy call center services, reviewing drug claims, managing prior authorizations, and ensuring adherence to health plan benefit designs.
Role type
Senior Pharmacy Coordinator (Call Center Operations)
Builds
Pharmacy call center services and drug claim adjudication workflows
Domain
Healthcare / Pharmacy Benefit Management
Required skills
Pharmacy prescription claims processing, Prior authorization review, Drug benefit design knowledge, Member claim history analysis, Coordination of benefits, OnBase system proficiency, Argus IPNS system proficiency, Medicaid/Medicare regulations knowledge
Preferred skills
Associate degree, Pharmacy technician certification, Managed care formulary management experience, Retail pharmacy experience, Medicare drug benefit design knowledge
Technologies
OnBase, Argus IPNS, Microsoft Outlook, Microsoft Word
Responsibilities
Respond to physician and pharmacy network provider inquiries regarding medication requests and claim edits; Review and evaluate non-formulary drug exception requests; Prioritize requests for drug authorizations or denials; Document all authorizations and denials in compliance with state and federal regulations; Populate authorization and denial information fields within the OnBase information system; Enter all authorizations into the Argus IPNS information system; Identify and report improper coordination of benefit billing practices.
Seniority
Senior, hands-on IC