pharmacy specialist

CorVel Corporation

<div><p>The Pharmacy Specialist will work to support people who have been injured on the job. This role will respond to departmental inquiries regarding pharmacy benefits for pharmacy lines of business. The Pharmacy Specialist works closely with pharmacies, claims adjusters, providers, claimants and other CorVel offices to quickly and professionally answer questions. This position is not quota driven, nor is this a &ldquo;scripted&rdquo; position. This role requires a service minded individual, active listening and pro-active problem solving skills to be successful. The Pharmacy Solutions team hours are 8 a.m. to 11 p.m., Monday through Friday.
</p><p>This is a remote role.</p><br>
<p></p>
<p><b>
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:</b></p>
<ul>
<li>Answer pharmacy calls and e-mails in a prompt, friendly and professional manner</li>
<li>Assure escalated issues are referred to the management team</li>
<li>Consult with claims adjusters regarding medications and pharmacy eligibility</li>
<li>Utilize proprietary programs to track inquiries and enter prescription information</li>
<li>Participate in training of new representatives and personal, ongoing professional development, as required</li>
<li>Work on rejection report lines</li>
<li>Additional duties as assigned</li></ul><br>
<p></p>
<p><b>
KNOWLEDGE &amp; SKILLS:</b></p>
<ul>
<li>Familiarity with external pharmacy adjudication system and internal billing/claims management applications</li>
<li>Excellent verbal and written communication skills</li>
<li>Exceptional decision-making and problem-solving abilities</li>
<li>Ability to work independently and within a team environment</li>
<li>Computer proficiency with knowledge of Microsoft Office applications</li></ul><br>
<p></p>
<p><b>
EDUCATION &amp; EXPERIENCE:</b></p>
<ul>
<li>High school diploma or equivalent</li>
<li>Some customer service and/or call center experience</li>
<li>Pharmacy Benefits Management experience preferred</li>
<li>Pharmacy Technician Certification preferred</li></ul><br>
<p></p>
<p><b>
PAY RANGE:</b></p>
<p>
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.</p>
<p>
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.</p>
<p>
Pay Range: $13.38 - $23.42 per hour</p>
<p>
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management</p>
<p>
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.</p><br>
<p></p>
<p><b>
ABOUT CORVEL</b></p>
<p>
CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).</p>
<p>
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.</p>
<p><b>
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.</b></p>
<p>
#LI-Remote</p></div>

Pharmacy Specialist I

US Department of Veterans Affairs

Clinical Pharmacy Specialist

Clinical Pharmacy Specialist (PGX)

Optum

<div><p>Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start <b>Caring. Connecting. Growing together.</b></p><p></p><p><br>
The Access &amp; Reimbursement Pharmacy Specialist will be responsible for the benefit verification research and benefit initiation of pharmacy claims. To ultimately obtain patient access the role includes ongoing follow up on prior authorizations and appeals. The role also includes identifying and obtaining financial assistance.</p><p></p><p><br>
This position is under direct supervision from the Access &amp; Reimbursement Supervisor This position relies heavily on the ability to accurately follow directions, thoroughly research, address and communicate prescription insurance coverage requirements as well as a comprehensive knowledge of Medicare, Medicaid and commercial plan structures and standards.</p><p></p><p><br>
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.</p><p></p><p><b><br>
Primary Responsibilities:</b></p><ul><li>
Knowledgeable and proficient in pharmacy benefit structure of all major payer types including government and commercial payers</li><li>
Knowledgeable and proficient in the entire pharmacy prior authorization and appeals process for prescriptions medications</li><li>
Navigate calls to pharmacy benefit manager to determine and obtain patient benefit structure details, initiate overrides, and obtain contracting requirements</li><li>
Completes test claims or electronic verification of benefits when applicable</li><li>
Accurately collect the information required for each program and capture the information in a Customer Relationship Management system (CRM) or database</li><li>
Coordinates with board licensed healthcare professionals including nurses, pharmacists, or supervised pharmacy interns for information needed to complete Prior Authorizations, Appeals and third-party financial assistance forms</li><li>
Follows up with pharmacy plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes</li><li>
Effectively explains prior authorization and appeal approval or denial details with customers in a way that is easily understood to fit the audience's needs</li><li>
Keeps current with the requirements and eligibility criteria for copay assistance from public, private, and non-profit organizations related to assigned programs to assist customers with enrolling into third party financial assistance opportunities when applicable. This includes researching foundations available to support the patients' holistic needs</li><li>
Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs to complete Prior Authorization and Appeal forms</li><li>
Maintains a working knowledge of program guidelines, FAQ's, products, and therapeutic areas related to programs within the Frontier Therapies portfolio</li><li>
Responsible for reviewing, interpreting and reacting to data provided by clients and customers</li><li>
Coordinates the triage of patient prescription to the appropriate partner for fulfillment or administration</li><li>
Communicates customer statuses to the appropriate parties at specified intervals or as needed</li><li>
Resolve customer issues through basic troubleshooting and escalate potential problems or issues that require management's attention in a timely manner</li><li>
Maintains company, employee and customer confidentiality as well as compliance with all HIPAA regulations</li><li>
Provide recommendations to IT partners on system enhancements to better drive performance and quality</li><li>
Completes special duties or projects as assigned by leadership</li></ul><p></p><p><br>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.</p><p><b>
Required Qualifications:</b></p><ul><li>
2+ years of hands-on Pharmacy Claims Processing, Benefit Verification or Prior Authorization processing in an insurance or pharmacy setting</li><li>
3+ years of retail pharmacy experience</li><li>
Valid license, registration and/or certification, in good standing, to practice as a Pharmacy Technician as required by the Board of Pharmacy in the state employed</li></ul><p></p><p><b><br>
Preferred Qualifications:</b></p><ul><li>
Associate degree</li><li>
Retail Pharmacy experience</li><li>
Specialty Pharmacy experience</li><li>
Pharmacy Accreditation experience</li><li>
Work history working in a matrixed environment, call center, operations environment</li></ul><p></p><p><b><br>
Soft Skills:</b></p><ul><li>
Demonstrated ability to provide quality customer service</li><li>
Ability to manage more than one project or task at a time</li><li>
Meet deadlines and proactively communicates roadblocks</li><li>
Speak, listen and write in a clear, thorough and timely manner using appropriate and effective communication tools and techniques</li><li>
Strive for thoroughness and accuracy when completing tasks</li><li>
Ability to work independently</li><li>
Solid knowledge of Internet navigation and research</li><li>
Willingness to learn and grow in the position</li><li>
Participate in continuous quality improvement activities</li><li>
Be a team player and collaborate across functions</li></ul><p></p><ul><li><br>
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul><p><i>
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.</i></p><p><i>
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></p><p>
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.</p><p></p><p><b><br>
Application Deadline:</b> This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.</p><p><i>
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</i></p></div>

Access & Reimbursement Pharmacy Specialist

Montage Health

<div><div>Welcome to Montage Health&rsquo;s application process!</div><div>
Job Description:</div><div>
The Clinical Pharmacy Specialist will perform duties in the following areas across all lines of business, including Utilization Management, Formulary Support, Appeals and Grievances, and Audit and Reporting Support to support the pharmacy team.</div><div></div><div>
This position will perform duties reviewing coverage for medications under the pharmacy and medical benefits for all lines of business necessary. The Clinical Pharmacy Specialist utilizes established company guidelines to review requests from physicians, medical groups, pharmacies, and members for the utilization of prescription drugs and pharmacy benefits. The specialist will conduct, research, and resolve any inquiries, problems, or issues in a timely manner.</div><div></div><div>
The Clinical Pharmacy Specialist is responsible for supervising and directing the support services needed for pharmacy services across all lines of business. This team member will continuously look for ways to improve processes and contribute to corporate and department objectives by processing all requests in a prompt, professional and courteous manner.</div><div></div><div>
Responsibilities</div><div>
Utilization Management: Prior Authorization for Medical and Pharmacy Benefit (Medicare Part B and Part D; Commercial Plans)</div><ul><li>
Input, review and decision Medicare Part B requests for J codes, Q codes, and other medical benefits drugs/supplies.</li><li>
Track and triage coverage determinations and/or prior authorization requests submitted from providers and determine if a pharmacist review is required.</li><li>
Monitor prior authorization system to ensure turnaround times are met and contact providers for additional information to facilitate coverage determination reviews.</li><li>
Refer coverage determination requests for specialty drugs to a delegated vendor or client for processing when applicable.</li><li>
Communicate prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.</li><li>
Notify physicians, providers, and members of coverage determination request decisions.</li><li>
Oversight and preparation of correspondence, proposals, reports, spreadsheets, and forms.</li><li>
Assist in maintaining policies &amp; procedures, including editing, proofreading.</li><li>
Provide project management assistance to pharmacist and team as needed.</li><li>
Support member and provider calls regarding authorization, benefit inquiries, and resolution of pharmacy-related member questions as well as outbound customer service calls to members and delegated partners.</li><li>
Coordination and completion of intake/processing for pharmacy and medical authorization and appeal requests. Perform preliminary review for completeness and appropriate documentation. Triage and escalate to the appropriate clinical resource when needed.</li><li>
Utilize knowledge of member eligibility and benefit coverage information to respond accurately to authorization requests, which do not require review/consultation by a pharmacist.</li><li>
Support the pharmacist or Pharmacy Director with quality and STARS related measures, including outreach to members, providers, and pharmacies.</li></ul><div></div><div>
Formulary Support</div><ul><li>
Assist the Director in maintenance of the formulary and processing formulary change requests on a weekly basis.</li><li>
Support team in generating, maintaining, and reviewing Formulary Status Grids.</li><li>
Assist pharmacist in audits and quality checks on the current formulary status for accuracy and contract compliance.</li></ul><div></div><div>
Appeals and Grievances</div><ul><li>
Responsible for intake/entry and investigation/resolution of all prescription-related grievances received by the Plan or PBM</li><li>
Identify validity of appeal and send request to correct department as appropriate.</li><li>
Other appeal tasks as required.</li></ul><div></div><div>
Audit and Reporting Support</div><ul><li>
Assist pharmacist in a range of tasks necessary for pharmacy audit and recovery functions, including:<ul><li>
Perform audits and quality checks on active prior authorizations claims.</li><li>
Review paid claims for quantity and/or billing discrepancies.</li><li>
Investigate member complaints and documentation of findings according to Fraud Waste and Abuse (FWA) program.</li></ul></li><li>
Support pharmacist in monitoring delegated PBM functions through generation of reports and the review of reports such as daily rejected claims, in depth monthly review of approved and rejected claims, monthly review of posted/published formulary, monthly review of redeterminations and prescription related grievances, and Coverage Gap Discount discrepancy reports.</li><li>
Communicate or fax inquiries to pharmacies related to review findings and updates pharmacy database with incoming phone calls, faxes, and e-mails.</li><li>
Responsible for the maintenance of consistent processes and updating of policies and procedures and standard operating procedures as assigned.</li><li>
Assist pharmacist with department preparation for internal and external audits (building case files, universes, evidence of compliance and other documentation as needed)</li><li>
Medicare Part D Operations, including:<ul><li>
Assist with identifying and correcting eligibility and group issues.</li><li>
Process member claims and pharmacy claims.</li><li>
Review and process Medicare Advantage Prescription Drug Event (PDE) data, such as:<ul><li>
Identification of errors with member eligibility, Low Income Subsidy Cost Sharing, as well as processing Institutional, ESRD and Hospice prescription drug claims.</li><li>
Monitor and report prescription drug metrics, including but not limited to, review of B versus D drugs, appropriate Copay and Deductible calculation, and corrective actions for informational and rejected PDE claims.</li></ul></li></ul></li></ul><div></div><div>
Other Responsibilities</div><ul><li>
Serve as a training resource for other team members and identifies and shares best practices.</li><li>
Provide administrative support to the Pharmacy Director for Committees chaired by Chief Medical Officer.</li><li>
Assist with pharmacy matters across all lines of business.</li><li>
Develop professional relationships with physicians, physician&rsquo;s office staff, medical management staff and/or pharmacists.</li><li>
Demonstrate understanding and accurate interpretation to support compliance with regulatory standards, e.g. Medicare Advantage and HIPAA.</li><li>
Prioritize and plan work for completion in a timely manner, coordinating with others as needed, and meeting deadlines set for all phases of work.</li><li>
Maintain a high level of professionalism, safeguarding and preserving the confidentiality of all information in accordance with HIPAA regulations.</li><li>
Demonstrate the ability to adapt to changes in the workload and responsibilities.</li><li>
Perform other activities and functions related to pharmacy or UM as delegated by the pharmacist or Pharmacy Director to evolve with business needs.</li></ul><div></div><div>
Experience</div><ul><li>
Problem Solving and Decision Making: Identifies, analyzes, organizes, and solves problems and issues in a timely, effective manner; uses data and input from others to make sound, timely decisions even in the face of uncertainty.</li><li>
Integrity: Consistently honors commitments and takes responsibility for actions and words.</li><li>
Flexibility: Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.</li><li>
Inclusiveness: The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.</li><li>
At least three years of experience in a health plan or PBM performing prior authorization for drugs, particularly Medicare Part B and Part D.</li><li>
Attention to details in obtaining complete and accurate information.</li><li>
Ability to key data accurately and efficiently.</li><li>
Ability to communicate effectively, including written and verbal communication skills.</li><li>
Bilingual in English and Spanish preferred.</li><li>
Business English and/or technical vocabulary related to health care industry (insurance/medical terminology).</li><li>
Basic knowledge of medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-10, CMS 1500, etc.).</li><li>
Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.</li><li>
Excellent phone manner and ability to handle multiple phone lines.</li><li>
Ability to identify and trouble-shoot problematic issues independently.</li><li>
Ability to follow clinical criteria and instructions to approve prior authorization requests.</li><li>
Must be able to meet established deadlines.</li></ul><div></div><div>
Education</div><div>
Minimum A.A. degree</div><div></div><div>
Licensure/Certifications</div><div>
License/Certification: Active Pharmacy Technician License required.</div><div></div><div>
Pay Rate: $30 per hour</div><div></div><div>
Equal Opportunity Employer</div><div></div><div>
Assigned Work Hours:</div><div>
Full time (remote)</div><div></div><div>
Position Type:</div>
Regular</div><div></div>

Clinical Pharmacy Specialist - Aspire Health

Moffitt Cancer Center

<div><div>Clinical Pharmacy Specialist - BMT/CI Clinical Research $25,000 Sign On.
<br>
<br>
<b>Summary:</b></div><div><b>
Position Summary:</b></div><div>
We are currently seeking a passionate and highly skilled Clinical Research Pharmacy Specialist to join our world-class Blood and Marrow Transplant and Cellular Therapy pharmacy team. This unique role will play a critical part in the care of patients enrolled in clinical trials and undergoing autologous and allogeneic stem cell transplants, CAR-T therapy, and other emerging cell-based treatments&mdash;contributing directly to some of the most complex and high-acuity cases in oncology.<br>
</div><div>
As part of our collaborative BMT and Cellular Therapy service, you will work alongside top transplant and cellular therapy specialists, Investigational Drug Services, and research teams in both inpatient and outpatient settings focusing on implementation of trials into daily clinical pharmacy practice. Your expertise in clinical trials in BMT/CI area will directly impact patient outcomes and the advancement of cellular therapies.<br>
</div><div><b>
Experience the Moffitt Pharmacy Difference:</b></div><ul><li>
Practice at the forefront of hematologic malignancies and cellular therapies, delivering high-acuity, patient-centered care to individuals undergoing stem cell transplant and CAR-T therapy who are enrolled in clinical trials while functioning with a high degree of clinical autonomy.</li><li>
Live and work in sunny Tampa, Florida, offering year-round warm weather, beautiful beaches, and a vibrant cultural scene &mdash; plus championship-level sports teams including the Buccaneers, Lightning, and Rays.</li><li>
Our Pharmacist Clinical Ladder Recognition Program is designed to recognize and reward clinical excellence.</li><li>
Benefit from robust professional development opportunities, including teaching, mentorship, research, and leadership training, with institutional support to present your work and network at national professional conferences and meetings.</li><li>
Enjoy flexible scheduling options designed to support work&ndash;life balance while maintaining excellence in patient care.</li></ul><div>
</div><div><b>
Responsibilities:</b></div><ul><li>
Participate in clinical trial start up by collaborating with Investigational Drug Services, research teams, transplant and cellular specialists, and clinical pharmacy teams including standardized treatment order set review, attendance of site initiation visits and implementation meetings, creation of study summaries for clinical pharmacy team.</li><li>
Ensure safe and effective medication use in patients on clinical trials by providing clinical expertise during multidisciplinary rounds including overseeing administration and monitoring of high-risk therapies such as cellular therapy agents.</li><li>
Conduct prospective medication order review and timely interventions to support complex care needs in patients receiving investigational agents.</li><li>
Serve as a trusted investigational medication expert, providing education, consultation, and evidence-based guidance to pharmacists, physicians, advanced practice providers, nurses, and patients. Support education efforts related to investigational agents.</li><li>
Lead and contribute to quality and safety initiatives, including clinical guideline development, policy implementation, workflow and EMR optimization, and cost-containment strategies for high-cost and high-risk investigational therapies.</li></ul><div><br>
<b>
Credentials and Qualifications:</b></div><ul><li>
Minimum of Bachelor's degree in Pharmacy required.</li><li>
Licensed as a Pharmacist in the state of Florida required.</li>
Completion of PGY-2 Residency in area of specialization, or PGY-1 residency with a minimum of 2 years clinical practice experience in specialty area, or 4 years of clinical practice experience in specialty area.<br>
<li>
</li></ul><div>
Monday-Friday.</div></div>

Clinical Pharmacy Specialist – BMT/CI Clinical Research

Onco360

<div><div>We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in<b> Houston, TX. </b>This will be a Full-Time position.<b> This position must be located within driving distance to our pharmacy, with a hybrid work style.</b></div>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div><b>Starting salary from $21.00 an hour and up</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections</div>
<div></div><div>Pharmacy Adjudication Specialists at Onco360...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.</li>
<li>Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.</li>
<li>Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.</li>
<li>Document and submit requests for Patient Refunds when appropriate.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills</li></ul></li></ul></div></div>

Pharmacy Adjudication Specialist

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