Pharmacy Services Coordinator (Greater Kansas City Area)

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute Annual incentive bonus plan based on... company achievement of goals Time away from work including paid holidays, paid time off and volunteer time off Professional development courses, mentorship opportunities, and tuition reimbursement program Paid parental leave and adoption leave with adoption financial assistance Employee discount program Job Description Summary: The Pharmacy Services Coordinator provides information management services throughout the organization on behalf of the Clinical Pharmacy Services Department. This includes both medical and pharmacy benefit drug claims research and review as well as drug utilization management including prior authorization, step therapy, quantity limits, etc. The Pharmacy Services Coordinator is first-line issue resolution for all matters pharmacy or drug related, not requiring clinical review. Job Description Updates, maintains and uses various pharmacy services reference tools. Develops, generates and analyzes routine and ad hoc utilization reports at the product, member, group and pharmacy level. Researches and reviews pharmacy-related claims, including both pharmacy and medical benefit claims. Resolves claims issues with Pharmacy customer service group and other escalations Regularly converses by phone with members and providers, either directly or as transferred by customer service representatives. Coordinates printing and mailing of member, physician, and pharmacy notifications. Coordinates meetings with pharmaceutical industry representatives as well as the Medical and Pharmacy Management Committee. Executes utilization management program according to policies and procedures. Receives requests for prior authorizations (PA?s) of medications. Reviews PA?s using a defined, approved script for each medication. Determines appropriateness of request, or, as necessary, refers to clinical pharmacist for certification of medical appropriateness. Enters pharmacy PA?s into PBM vendor pharmacy system claims system and medical PA?s into medical claim system. Generates letters of decision according to established policies and procedures and turnaround times. Routes clinical determinations to the pharmacist and/or Medical Director. And other duties as assigned. Minimum Qualifications Associate?s degree from a college or university in business administration, health care management, or other relevant academic field, or equivalent combination of education and experience. 3+ years of experience in positions providing intimate familiarity with medical and pharmaceutical terms. Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information in one-on-one and small group situations to customers, clients, groups of managers, and other employees of the organization. Ability to calculate figures and amounts such as discounts, dosages, days? supply, and percentages. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Advanced keyboarding skills. Advanced knowledge of Microsoft Windows, Word and Excel. Intermediate level knowledge of Outlook. Preferred Qualifications Advanced knowledge of and ability to use PowerPoint, and Access. Advanced knowledge of and ability to use PBM vendor pharmacy system and Facets as well as any other system required to perform job duties. Working knowledge of and ability to use Business Objects. Other specialized knowledge and skills preferred include HIPAA requirements; UM denial/appeals specifications; and NCQA, URAC, and state and federal UM requirements. MO or KS Pharmacy Technician License, PTCB Certification. Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability. At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us! Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to [email protected]. EOE/M/F/Vets/Disability Affirmative Action Employer Equal Opportunity Employer Know Your Rights: Workplace Discrimination is Illegal E-Verify Participation Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies IER Right to Work FMLA Pay Transparency Employee Polygraph Protection Act

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