Pharmacy Operations Coordinator
Career Center•Franklin, TN
About The Position
The Pharmacy Operations Coordinator is responsible for performing oversight and monitoring of the pharmacy benefit manager (PBM), for activities related to the appropriateness of claims adjudication, and for providing support of CMS regulatory requirements, and other Plan Operations. ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
Requirements
- Maintain regular and reliable attendance
- Attention to detail
- Ability to work in a high demand fast pace environment
- Experience in planning and implementation
- Strong analytical skills
- Strong leadership and collaboration skills
- Extensive knowledge in Medicare compliance
- Customer and quality focus
- Follow-up and solve any open items in a timely manner
- Adhere to all compliance requirements
- Adhere to Centers of Medicare and Medicaid Services (CMS) regulations
- Successful completion of required training
- Handle multiple priorities effectively
- Independent discretion/decision making
- Make decisions under pressure
- High school diploma or equivalent required
- Experience in the pharmacy department of a Medicare Advantage or Part D plan is preferred
- Pharmacy technician
Responsibilities
- Serve as primary contact between Plan and PBM
- Perform PBM oversight and monitoring
- Report and escalate performance deficiencies and status to management and the compliance department
- Formulary Management: Recognize formulary requirements: non-formulary, prior authorization (PA), Step Therapy (ST), Quantity Limit (QL) and review, outreach, and track rejected pharmacy claims
- Responsible for ensuring regulatory requirements are met for coverage determinations/redeterminations
- Lead annual readiness
- Serve as a liaison with Enrollment Department to ensure appropriate member eligibility processing
- Support CMS Plan reporting, audits, and monitoring activities and submissions
- Assist and track in-coming calls from agents, pharmacies, nursing homes, providers/nurses, and members
- Coordinate monthly website updates
- Monitor and report on departmental metrics
- May be assigned to work on special projects and business initiatives
- Other duties as assigned
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
