Note: The job is a remote job and is open to candidates in USA. BlueCross BlueShield of Tennessee is hiring a Clinical Pharmacy Specialist to support Commercial and Exchange pharmacy coverage reviews and help ensure timely, appropriate access to pharmacy benefits. The role handles authorizations, claims, provider and member inquiries, and related review and quality activities.
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
Skills
- Strong computer and organizational skills
- Attention to detail
- The ability to navigate complex information
- Experience in Medicare, Medicaid, retail pharmacy, or managed care settings
- High School Diploma or equivalent
- 2 years - Pharmacy experience required
- National Certification as Pharmacy Technician (PTCB)
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- 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
- Previous experience with coverage review processes
- Candidates with MHK experience
Benefits
- Remote work
- Tools and resources to support employees’ success
- Growth and continuous learning
Company Overview
Company H1B Sponsorship