Pharmacy Benefit & Authorization Specialist

Palmetto Infusion Careers•Irvington, AL

About The Position

The Pharmacy Benefit Specialist will serve as the primary escalation point for all pharmacy benefit-related issues. This role is critical in supporting intake processes, resolving complex claim issues, and developing strategic solutions to address root causes.

Requirements

Pharmacy Technician Certification required
2 years of experience related to pharmacy benefits and prior authorization processes
strong understanding of pharmacy benefit management and claims processing.
Proficient at partner programs (i.e.: MS Outlook, Word, Excel).
Ability to cope with ambiguous, changing environment while under pressure in a calm manner.
Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion.

Responsibilities

Act as the escalation point for all pharmacy benefit-related concerns, including handling calls from patient services and pharmacy teams regarding claim issues.
Run test claims during the intake process to proactively identify potential issues.
Advocate for prior authorization approvals and assist with challenging cases.
Monitor pending referrals to identify opportunities for intake process improvements.
Provide oversight of pharmacy claims processing, including monthly reporting to identify trends and areas for improvement.
Develop and maintain job aids and training materials to support ongoing education efforts within the team.
Audit PBM prior authorization request submissions to ensure accuracy, compliance, and timeliness.
Provide expert support to address and resolve claim rejections efficiently.
Collaborate with cross-functional teams to build and refine a decision tree, determining when claims should be billed through pharmacy benefits versus medical benefits.
Offer input related to PBM settings within claims systems to optimize workflows and maximize efficiency.