Pharmacy Administrative Coordinator - Oklahoma City, United States - GLOBALHEALTH HOLDINGS LLC

Description

Job Details

Job Location
Any Location Remote US - Oklahoma City, OK

Remote Type
Fully Remote

Position Type
Full Time

Education Level
High School or Equivalent

Travel Percentage
None

Job Shift
Day

Job Category
Pharmacy

WHO WE ARE:

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

WHO YOU ARE:
This position will provide administrative support to the Supervisor, Clinical Pharmacist and the Pharmacy Department. This pharmacy staff member will provide project coordination and oversight under the direction of the Supervisor over key projects that enhance service delivery of the pharmacy benefit and overall member experience. This role provides non-clinical support to the clinical pharmacist(s) reviewing coverage determinations by obtaining medical records and other information as necessary, communicating with physicians offices, and with members. Additionally, the Administrative Coordinator provides support to Pharmacy staff to assist in resolving member pharmacy complaints, helping the clinical pharmacists and department director maintain timeliness in reporting processes, and participating in department projects to assure timely completion.

ESSENTIAL JOB FUNCTIONS:

• Develops and maintains resources, reports and policies related to the administration of the pharmacy benefit for applicable lines of business.
• Provides and maintains reports for disclosure in internal committees and submission to meet State and Federal reporting requirements.
• Develops and maintains documentation of departmental standards of operation, training, and personnel documents.
• Maintains knowledge of pharmacy benefit plans, formularies, regulations, and other policies associated.
• Provides clerical support in committee, department, and other meetings as needed.
• Receives incoming prior authorization requests and forwards to responsible party for each applicable line of business for review.
• Verifies eligibility, timeliness and medical record completeness of coverage determination cases and follows up with the provider as necessary for Commercial plans.
• Contacts pharmacies upon approval of medication prior authorizations to ensure accuracy of claim payment for applicable lines of business.
• Ensures timely processing and review of coverage determinations to meet departmental goals and state/federal specific benchmarks for timeliness.
• Responds to member and provider inquiries related to the pharmacy benefits for the applicable lines of business.
• Assists in the retrospective coverage review of prescription claims to ensure accurate billing under the proper Medicare benefit
• Collaborates with PBM(s) and internal partners in maintaining updates to the pharmacy directories and formularies for applicable lines of business. This includes meeting any state and federal reporting requirements.
• Acts as a pharmacy resource for other internal partners
• Supports company efforts in meeting NCQA requirements and enhancing CMS STARs rating.
• Refers unresolved customer grievances to designated departments for further investigation.
• Contacts members and/or providers to provide timely responses to inquiries.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.

Qualifications

EDUCATION AND EXPERIENCE:

• High School diploma or equivalent
• Nationally Certified Pharmacy Technician - Preferred

KNOWLEDGE, SKILLS AND ABILITIES:

• Excellent communication skills, both written and oral
• Strong working knowledge of Microsoft Word
• Can work independently and with a group
• Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
• Must have reliable transportation
• Self-motivated
• Confident and tolerant while working with difficult customers

WORK ENVIRONMENT:

• Fast-paced working environment
• Cubicle-style office setting
• Potential for difficult customer interactions
• Smoke-free environment
• Must tolerate long periods of time sitting at a desk
• Will require applicant to be able to stay focused on job tasks in a noisy office environment
• Requires typing and mouse clicking throughout the day

TRAVEL:

Travel is not required

SUPERVISORY RESPONSIBILITY:

This position does not have any supervisory responsibilities.

OTHER DUTIES:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.