The Pharmacy Services Specialist will utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, and providers to ensure the efficient, timely, and effective delivery of pharmaceutical products and services to Alliance members. Working under the guidance of a clinical pharmacist and in coordination with Pharmacy Benefit Manager (PBM) technical support, this position will be responsible for completing daily pharmacy service operations and supporting the clinical pharmacists and Director, Pharmacy Services. This position will perform multiple concurrent duties and assignments effectively and accurately. The Pharmacy Services Specialist will develop and maintain effective working relationships with all internal and external customers.
Principal responsibilities include:
· Process Pharmacy Authorizations (PA) in a timely manner according to the regulatory requirements.
· Perform ad-hoc audit of the pharmacy authorization letters and claims under the guidance of a pharmacist.
· Create and prepare ad hoc reports as well as recurring reports using pharmacy reporting tool.
· Retrieve drug-specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy-related functions and operations.
· Provide administrative support to the Pharmacy department.
· Process member reimbursement requests.
· Update content of the pharmacy page on the Alliance’s website.
· Provide administrative support to P and T meetings including taking minutes, managing the process of member and provider outreach letters.
· Manage the PBM formulary and benefit change requests.
· Resolve claims disputes between providing pharmacies, the pharmacy claims administrator, the Alliance Claims department, and other entities as necessary.
· Interpret and articulate pharmacy management program policies and procedures to pharmacy providers, other providers, Alliance staff, external agencies, and others as required.
· Support Clinical Pharmacists to resolve all pharmacy-related member complaints and grievances and appeals including those related to the pharmacy authorization process.
· Provide problem-resolution for members who encounter barriers to accessing pharmaceutical services with an emphasis on serving those members who are chronically ill and disabled.
· Participate in corrective action plans from internal and external audits.
· Perform other duties and special projects as assigned.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor’s Degree or relevant work experience.
· Completion of an accredited Pharmacy Technician training program required.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Minimum one year online computer prescription processing and claims submission procedures experience required.
· Minimum one year experience as a Pharmacy Technician in an ambulatory, community, home infusion, long term care, or managed care setting.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Strong verbal and written communications skills.
· Experience in computer skills regarding data management and pharmacy prescription processing systems.
· Experience in prior-authorization procedures.
· Experience with Medi-Cal or low -income population.
· Ability to diffuse difficult situations in a professional and calm manner.
· Knowledge of drug nomenclature, basic pharmacology, dosage calculations, units of measure, prescription filling techniques, prescription documentation requirements, pharmacy laws and regulations, basic managed care pharmacy principles and insurance coverage issues.
· Knowledge of PBM operations and procedures.
· Knowledge of basic managed health care principles.
· Knowledge of pharmacy-related organizations and resources.
Extensive experience in the use of Windows, Microsoft Word, Excel, Power Point and Outlook.
$21.36 - $33.65/hour