POSITION SUMMARY
This Specialty Rx Administrator acts as a liaison between the retail and specialty pharmacy and the prescribers to document, submit, communicate outcomes and appeals. The Specialty Rx Liaison III manages all pharmacy and medical prior authorization requests. They will assist all members who express financial concerns regarding their medications as well as communicate escalations as appropriate.
ESSENTIAL FUNCTIONS
- 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
EDUCATION
- Bachelor’s degree or equivalent work experience required.
EXPERIENCE AND SKILLS
- 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.
- Knowledge of medication use in RA, transplant, Hepatitis C, infectious disease, and or oncology preferred.
- 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.
POSITION COMPETENCIES
- Accountability
- Analytical Thinking
- Collaboration
- Communication
- Customer Focus
- Functional Expertise
- Initiative
PHYSICAL DEMANDS
- This is a standard desk role requiring extended sitting and computer work.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Bachelor's degree or equivalent work experience; 5+ years professional experience with pharmacy/medical benefits, specialty medications, prior authorization; Microsoft Office proficiency; reliable high-speed internet.
Key Responsibilities
- managing prior authorizations
- negotiating pricing
- processing claims
Skills & Tools
Microsoft Office Suite, QicLink
Job Details
- Category: Healthcare Services - Pharmacy
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — United States
- Salary: USD 50,000 – 55,000 / year
- Languages: English
Benefits
- Generous paid time off
- Tuition reimbursement
About Allied Benefit Systems
A benefits administration company managing pharmacy and medical prior authorization requests. — Industry: Healthcare