Pharmacy Operations Support Specialist - St. Louis, Mo

Lumeris

1d•Onsite

About The Position

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. This position performs duties in one or more of the following areas: Medicare Part D rejected claims management, formulary management, pharmacy prior authorizations, and assists Medicare Part D Customer Service call center team members. Lumeris is bringing common sense back to the business of healthcare by empowering value-based care. We create the partnerships and perspectives that are making healthcare safer, more affordable and more personalized for providers, patients and payers alike. We were founded on the belief that it should be easier to provide the right care, at the right time, at the right cost. Our model is bringing that belief to life, improving outcomes and empowering financial sustainability along the way. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.

Requirements

High school diploma, GED, or equivalent
Current Certified Pharmacy Technician License in good standing
1+ years Pharmacy Technician or retail pharmacy experience or the knowledge, skills, and abilities to succeed in the role
Flexible with the ability to consistently meet deadlines and adapt to a changing work environment
Strong planning, time management, and organizational skills
Team player with a positive attitude
Strong professional verbal and written communication skills
Basic PC skills, including Microsoft Excel, Word, and Outlook

Nice To Haves

2+ years of experience in retail pharmacy
2+ years of Pharmacy Technician experience
Part D health plan or pharmacy benefit management experience
Certified Pharmacy Technician License

Responsibilities

Reviews rejected pharmacy claims for appropriateness.
Becomes a pharmacy claims processing subject matter expert and triages claims issues.
Becomes subject expert with Medicare Part D policies and procedures.
Reviews transition claims reports.
Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs.
Supports medical pharmacy prior authorizations and Medicare Part D drug reconsiderations.
Supports Medicare Part D call center questions and issues received from members, pharmacies, and providers.
Supports compliance functions and requests.
Supports quality programs including STARS.
Conducts retrospective claims reviews.
Complies, interprets, documents, and tracks findings from claims monitoring data.