Pharmacy Benefit Coordinator

US-LA-Peoples Health- Metairie
Job ID
3498
Category
Support - All

Overview

Position Purpose

 

The Pharmacy Benefits Coordinator will create an exceptional experience for our providers, pharmacists, other PHN employees and internal and external customers while assisting them with Pharmacy issues, inquiries and concerns. 

 

The Pharmacy Benefits Coordinator will facilitate coverage of prescription drugs for members by interacting with providers, pharmacists, other employees and the Pharmacy Benefits Manager.

Responsibilities

Principal Responsibilities

  • Provides real-time on-line access to members' prescription records in order to obtain instantaneous information and to disseminate and/or to process overrides , when appropriate
  • Serves as liaison to providers, pharmacists, member services, and health services in ensuring proper utilization of pharmacy benefit.
  • Facilitate the timely processing, notification and documentation of Organizational Determinations to members, providers and pharmacies
  • Acts as a resource regarding information on the pharmacy benefit to include the drug tiers, the adjudication process, drug amount accumulations, and information regarding prior authorizations.
  • Responsible for requesting and processing of documents regarding prior authorization and exceptions processes and documenting such requests.
  • Ensure DMR’s are processed according to guidelines and time-frames.

Qualifications

Core Competencies

  • Professionalism
  • Commitment to providing exceptional quality service to our members, providers, customers and staff
  • Ability to work as part of a team
  • Strong communication and interpersonal skills
  • Excellent documentation skills
  • Ability to work effectively and cooperatively with all staff
  • Attention to detail and accuracy
  • Projection of a positive willing attitude

Experience/Education

  • High school diploma or equivalency required
  • College degree highly preferred
  • Minimum of 6 months experience handling pharmacy requests for authorization and over-rides using real time,on-line authorization software preferred
  • Knowledge and experience utilizing MS Word, Excel, and Outlook
  • Experience working with Windows Filing Techniques highly preferred 
  • Experience with AMISYS, MACESS program systems, preferred 
  • Working knowledge of CMS/Accreditation requirements, preferred

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