Job Information
CAREOREGON INC Pharmacy Benefit Specialist II in MILWAUKEE, Wisconsin
JOB REQUIREMENTS: Career Opportunities: Pharmacy Benefit Specialist II (24256) Requisition ID 24256 - Posted 05/17/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (16) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Benefit Specialist II Exemption Status Non-Exempt Department Pharmacy Manager Title Pharmacy Benefit Operations Supervisor Direct Reports n/a Requisition # 24256 Pay and Benefits Estimated hiring range \$45,850 - \$55,500 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a fully remote role, but you must reside in one of the listed 9 states. You are required to work Pacific Standard Time. Job Summary This position is responsible for working with CareOregon members, their providers, and pharmacies to support the pharmacy benefit and prescription needs under the major medical benefit. This is an advanced level support position, requiring Pharmacy Technician Certification. Core responsibilities include customer service, claims processing, prior authorizations, formulary exceptions, appeals, grievances, and project participation. Essential Responsibilities Customer Service and Claims Processing Communicate in a professional and respectful manner. Maintain confidentiality within HIPAA regulations and function on \"need to know\" principles. Respond to drug coverage inquires in an accurate and timely manner to members, members\' representatives, providers, and CareOregon staff. Educate members, providers, pharmacies, and CareOregon staff about the CareOregon formularies and pharmacy benefit policies. Document all customer service activities according to organization requirements. Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits and coverage of drugs under the major medical benefit. Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance. Data Entry and Clerical Support Sort incoming faxes and distribute according to assignments. Maintain files according to unit protocols. Perform data entry into the claims processing system, document management systems, databases and spreadsheets as assigned. Clerical Assistance for pharmacy projects, including, but not limited to distribution of education materials to members, providers or pharmacies, letters & mailings, and reports. Prior Authorizations... For full info follow application link. We are an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, and other protected characteristics. The EEO is the Law poster is available here. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/186441B4A05D4CF1