Pharmacy Coordinator Senior

Highmark Inc.

This is a call center outreach position. This jobprovides front line staff guidance and ensures effective and efficient delivery of pharmacy call center services. The Pharmacy Coordinator is responsible for supporting Highmark Wholecare’s pharmacy programs with a focus on medication adherence and optimizing member health outcomes. This role involves a high volume of daily contacts with members, physicians, and pharmacies to address medication-related issues, promote adherence, and ensure appropriate medication utilization.

Work Schedule for this position is Monday/Wednesday/Friday 8:30 AM - 5:00 PM EST & Tuesday/Thursday 9:00 AM - 5:30 PM EST

• Communicate effectively with physicians and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner.
• Interact with staff to implement processes and effectively solve problems.
• Conduct outbound calls to members to discuss their medication regimens, identify barriers to adherence, and provide education and support.
• Contact physicians and pharmacists to clarify prescriptions, obtain prior authorizations, and discuss alternative therapies to improve medication adherence and reduce costs.
• Collaborate with internal teams, including pharmacists and case managers, to develop and implement strategies to improve medication adherence.
• Document all interactions and interventions accurately and completely in the appropriate systems.
• Monitor member medication adherence through claims data analysis and other available resources.
• Identify and resolve medication-related problems, such as potential drug interactions, adverse effects, and therapeutic duplications.
• Provide excellent customer service to members, physicians, and pharmacies.
• Maintain current knowledge of pharmacy practices, medications, and relevant healthcare regulations.
• Meet or exceed daily contact goals and quality standards.
• Contact physician network providers to obtain necessary and/or additional information when necessary.
• Consult clinical pharmacists for guidance and assistance as necessary.
• Identify and report improper coordination of benefit billing practices through paid claims review.
• Complete other assigned duties as specified.

• High school diploma or GED
• Experience in pharmacy prescription claims processing/submission/payment

• Associate degree
• Pharmacy technician certification certificate
• Experience working in a managed care medication formulary management environment
• Working knowledge of retail pharmacy and/or third party prescription procession
• Strong background and understanding of medications and formulary terminology
• Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being familiar with applicable federal rules/regulations that remain consistent throughout the nation

• Excellent computer skills such as working knowledge of Microsoft Outlook, Word, On Base
• Excellent interpersonal, communication and attentive listening skills
• Strong organizational skills, detail oriented
• Demonstrated excellence in communication skills
• Demonstrated ability to work well with others
• Demonstrated ability to work in a fast paced, multi-task environment

Remote/Work from Home

Does this role supervise/manage other employees?

No

Is Travel Required?

No

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this…