- Serve as an account support to internal EmpiRx Health teams for adjudication, clinical review, and claims support-related matters.
- Ensure timely completion of day-to-day processes and assigned cases, adhering to standard operating procedures.
- Address escalation requests within a targeted 2-hour turnaround time.
- Manage claims override and prior authorization support, delivering exceptional white-glove service to clients and members.
- Act as a subject matter expert on the adjudication platform, demonstrating a keen understanding of claims support.
- Perform under the supervision of the ClinOps Manager and clinical pharmacists.
- Effectively communicate and interact with all other EmpiRx Health departments, fostering teamwork and unity.
- Minimum five years of pharmacy experience
- CPhT certification
- Minimum two years of claim adjudication experience
- Minimum two years of prior authorization experience
- Strong customer service orientation and commitment to delivering concierge-level service.
- Ability to work in a fast-paced environment.
- Time management skills with the ability to meet tight deadlines.
- Excellent verbal and written communication skills
- Proficient in Microsoft Office Suite
- BS (Bachelor's) Preferred
- Two years of experience in PBM, health plan, or equivalent preferred
- EmpiRx Health is on an extraordinary journey where excellence meets innovation.
- We are a collaborative team that encourages groundbreaking ideas, values open dialogue, and prioritizes continuous improvement.
- You will be part of a dynamic team where success is a shared celebration, collaboration fuels progress, and we redefine healthcare together.
- We offer a generous and competitive benefits package.
- You will share in the company's success through our discretionary bonus program.
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Clinical Operations Specialist - Orlando, United States - EmpiRx Health
Description
Job Description
Job DescriptionWho We Are:
EmpiRx Health is the leading clinically-driven, customer-first PBM company that puts the pharmacist at the center of its service model to optimize member care while substantially reducing costs for plan sponsors.
What We Do:
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients.
Who We're Looking For:
EmpiRx Health is experiencing unprecedented growth, and we're seeking a highly skilled and experienced clinical operations specialist. In this critical role, you will ensure proficiency with the adjudication platform, understand claim processing, and provide clinical review support. Clinic Ops staff must operate effectively for clients/members by assisting in support for overrides and clinical reviews promptly to ensure members are receiving white glove service. ClinOps will closely and collaboratively work with a call center, clinical pharmacists, and other internal EmpiRx Health teams.
If you're a highly motivated Clinical Operations Specialist with a robust grasp of pharmacy adjudication processes and clinical review procedures and are eager to make a meaningful impact in the healthcare industry, we encourage you to apply.
What You'll Do:
As a Clinical Operations Specialist, your role will encompass a wide range of responsibilities:
What You Need:
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're not just breaking down barriers but actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.
Your career at EmpiRx Health awaits – join us in shaping the future of excellence in healthcare.
Careers - EmpiRx Health
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