Note: The job is a remote job and is open to candidates in USA. Allied Benefit Systems is hiring a Specialty Rx Administrator to coordinate pharmacy and medical prior authorization requests between pharmacies, prescribers, members, and vendors. The role supports specialty carve-out programs, single case agreements, claims processing, and related internal and external communications.
Responsibilities
- Collect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacity
- Arrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member’s associated QicLink page
- Execute, manage, and provide on-going support of single case agreements
- Assist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendors
- Submit member referrals to third-party vendors managing specialty carve-out programs
- Serves as liaison for external vendors when implementing specialty carve-out programs
- Reviews current and newly requested vendor plan language to understand impact with governmental regulations
- Ensure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycle
- Collaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendor
- Management of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teams
- Other duties as assigned
Skills
- Bachelor's degree or equivalent work experience required
- At least 5 years of professional experience including comprehension of pharmacy and medical benefits, specialty medications, j-codes and their administration, limited distribution drugs as well as specialty pharmaceutical manager selection required
- Prior authorization experience required
- Excellent verbal and written communication skills
- Excellent organizational skills and attention to detail
- Excellent time management skills with a proven ability to meet deadlines
- Strong analytical and problem-solving skills
- Ability to prioritize tasks and to delegate them when appropriate
- Ability to function well in a high-paced and at times stressful environment
- Proficient with Microsoft Office Suite or related software
- Knowledge of medication use in RA, transplant, Hepatitis C, infectious disease, and or oncology preferred
Benefits
- Medical, Dental, Vision, Life and Disability Insurance
- Generous Paid Time Off
- Tuition Reimbursement
- EAP
- A Technology Stipend
- Remote-friendly culture offering flexibility and the comfort of working from home
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