Top 57 Pharmacy customer service Jobs in Pa

Pharmacy Coordinator
Highmark Inc. —Pennsylvania
- $19.39 - $24.19 an hour
- Full-time
- Remote
- Microsoft Word
- Microsoft Outlook
- Mid-level
In-House Pharmacy Call Center Representative
KeyScripts, LLC —Mechanicsburg, PA
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Office
- Health insurance
- Dental insurance
Quick Apply
Pharmacy Customer Care Associate
Grane Rx —Pittsburgh, PA
- $18 - $22 an hour
- Full-time
- Background check
- Customer service
- Word processing
- Paid training
- Health insurance
Quick Apply
Specialty Pharmacy Patient Care Coordinator
Thomas Jefferson University and Hospitals —Montgomery County, PA
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills
- AD&D insurance
- Disability insurance
5d
Specialty Pharmacy Patient Care Coordinator- KOP
Thomas Jefferson University and Hospitals —Montgomery County, PA
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills
- AD&D insurance
- Disability insurance
5d
Pharmacy Benefit Management (PBM) Client Experience Manager
CVS Health —Harrisburg, PA
- $46,988 - $122,400 a year
- Full-time
- 5 years
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
12d
Contracts Pharmacy Projects Specialist
Cencora —Conshohocken, PA
- $57,900 - $85,360 a year
- Full-time
- Writing skills
- Mid-level
- Bachelor's degree
- Paid parental leave
- Health insurance
Customer Service Representative
Blackburn's Physicians Pharmacy, Inc. —Tarentum, PA
- Full-time
- Anatomy knowledge
- Microsoft Outlook
- High school diploma or GED
- Opportunities for advancement
Quick Apply
Associate Director, Patient Service Operations
Incyte Corporation —Chadds Ford, PA
- 3 years
- Analysis skills
- Bachelor's degree
12d
Customer Service Representative - Erie, Pa
BLACKBURN'S PHYSICIANS PHARMACY —Erie, PA
- Full-time
- Microsoft Outlook
- Office
- High school diploma or GED
Quick Apply
Pharmacy Customer Service Associate
Walgreens —Bethlehem, PA
- $16 - $18 an hour
- Part-time
- Computer literacy
- Basic math
- Maintenance
- Continuing education credits
- Health insurance
Associate Account Executive - Pharmacy
Lockton, Inc. —Philadelphia, PA
- Full-time
- Customer service
- Mid-level
- 3 years
- Wellness program
- Health insurance
Cashier/Customer Service
BERKS DISCOUNT PHARMACY —Reading, PA
- $14 - $15 an hour
- Full-time
- In-person
- Entry level
Quick Apply
Client Success Manager / Sr Living / Long-Term Care Pharmacy
PharMerica —Philadelphia, PA
- Full-time
- Writing skills
- Mid-level
- 3 years
- Disability insurance
- Health insurance
Meritain Director, Pharmacy Client Management
CVS Health —Harrisburg, PA
- $68,000 - $174,134 a year
- Full-time
- Analysis skills
- Bachelor's degree
- Travel
- Health insurance
- Dental insurance
Patient Service Representative
Zeal Specialty Pharmacy —Pittsburgh, PA
- $19.00 - $21.50 an hour
- Full-time
- High school diploma or GED
- Computer skills
- In-person
- Health insurance
- 401(k)
Quick Apply
11d
Lead, Pharmacy Operations
Blink Health —Pittsburgh, PA
- 8 hour shift
- 5 years
- Office
- Bachelor's degree
Quick Apply
12d
Account Manager of Client Services / Skilled Nursing / Long-Term Care Pharmacy Services
PharMerica —King of Prussia, PA
- Full-time
- Computer literacy
- Mid-level
- 3 years
- Disability insurance
- Health insurance
Sr. Manager,Workforce Planning & Productivity
Pantherx Specialty LLC —Pittsburgh, PA
- Full-time
- Hybrid work
- Office
- Finance
- Analysis skills
- Paid holidays
- Disability insurance
Quick Apply
6d
Senior Manager, Client Solutions Manager Pharmacy
Knipper HEALTH —United States
- $100,000 - $130,000 a year
- Full-time
- Microsoft Outlook
- English
- Bachelor's degree
- Paid parental leave
- Health insurance

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Pharmacy Coordinator

Highmark Inc. -
Pennsylvania

Apply Now

Job Details

Full-time
$19.39 - $24.19 an hour

Qualifications

Customer communication
Medicare
High school diploma or GED
Medicaid health insurance
CMS regulatory compliance
Medicare regulations
Medicaid regulations
Medical claims submission
Medicaid

Full Job Description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.

ESSENTIAL RESPONSIBILITIES

Communicate effectively with physician and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner.
Interact with staff to implement processes and problem solves.
Respond to drug benefit design inquires or exception requests and evaluate/direct daily workflow within the department.
Prioritize requests for drug authorizations or denials.
Review of prior authorization criteria for drug products.
Recommend staffing adjustments necessary to appropriately maintain a level of high efficiency/productivity.
Ensure adherence to call center turn around time requirements associated with DPW/CMS regulations.
Take necessary steps to perform a complete and accurate evaluation of all non-formulary drug exception requests prior to approval, authorization or claim override.
Search member claim history profile and recommend formulary alternatives wherever feasible.
Contact physician network provider to obtain necessary and/or additional information when necessary.
Consult with staff clinical pharmacist for guidance and assistance as necessary.
Document all authorizations and denials completely, accurately, and in accordance with timelines as defined by state and federal regulations to insure appropriate notification issuance to prescribing physician and impacted member.
Populate all authorization and denial information fields within the OnBase information system.
Enter all authorizations into the Argus IPNS information system to allow claim adjudication.
Complete other assigned duties as specified.
Identify and report improper coordination of benefit billing practices through paid clams review.
Participate as pharmacy representative in onsite member appeals and grievances sessions.
Serve as a resource for technical staff.

QUALIFICATIONS:

Minimum

High school diploma or GED
Experience in pharmacy prescription claims processing/submission/payment.

Preferred

Associate degree
Pharmacy technician certification certificate
Experience working in a managed care medication formulary management environment
Working knowledge of retail pharmacy and/or third party prescription procession
Strong background and understanding of medications and formulary terminology
Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being familiar with applicable federal rules/regulations that remain consistent throughout the nation

Skills

Excellent computer skills such as working knowledge of Microsoft Outlook, Word, OnBase
Excellent interpersonal, communication and attentive listening skills
Strong organizational skills, detail oriented
Demonstrated excellence in communication skills
Demonstrated ability to work well with others
Demonstrated ability to work in a fast paced, multi-task environment

SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?

WORK ENVIRONMENT
Is Travel Required?
No

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$19.39

Pay Range Maximum:

$24.19

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Apply Now

Refine Your Search

pharmacy customer service jobs in pa

Pharmacy Coordinator

In-House Pharmacy Call Center Representative

Pharmacy Customer Care Associate

Specialty Pharmacy Patient Care Coordinator

Specialty Pharmacy Patient Care Coordinator- KOP

Pharmacy Benefit Management (PBM) Client Experience Manager

Contracts Pharmacy Projects Specialist

Customer Service Representative

Associate Director, Patient Service Operations

Customer Service Representative - Erie, Pa

Pharmacy Customer Service Associate

Associate Account Executive - Pharmacy

Cashier/Customer Service

Client Success Manager / Sr Living / Long-Term Care Pharmacy

Meritain Director, Pharmacy Client Management

Patient Service Representative

Lead, Pharmacy Operations

Account Manager of Client Services / Skilled Nursing / Long-Term Care Pharmacy Services

Sr. Manager,Workforce Planning & Productivity

Senior Manager, Client Solutions Manager Pharmacy

I want to receive the latest job alert for pharmacy customer service in pa

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