Clinical Pharmacy Specialist-2
BlueCross BlueShield of Tennessee · United States · 2 wk ago
RemoteRemoteHealthcareFull-time
Job Responsibilities
- Enter authorizations and test claims into the pharmacy benefit system to ensure appropriate claim adjudication.
- Handle incoming and outgoing phone calls from providers and/or members/members representatives to assist in completing coverage determinations and appeals.
- Monitor and answer emails and FACETs inquiries from internal customers regarding pharmacy reviews, appeals, claims issues, etc.
- Review daily pharmacy reports to ensure appropriate claims processing.
- Assist with departmental audits and quality improvement activities.
- May be required to work evenings, holidays and weekends to ensure adequate coverage to meet the business needs including on call rotations.
Job Qualifications
- Education: High School Diploma or equivalent.
- Experience: 2 years - Pharmacy experience required.
- Skills/Certifications: National Certification as Pharmacy Technician (PTCB), Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint).
- Other: Must be a team player, be organized and have the ability to handle multiple projects, Excellent oral and written communication skills, Strong interpersonal and organizational skills, Proven decision making and problem solving skills, Ability to work independently and with minimal supervision, Knowledge in Medical/Pharmacy terminology.