Pharmacy Services Specialist-2
Blue Cross and Blue Shield of North CarolinaAbout the role
Job Description
Assists in the development and management of pharmacy benefit administration for current and new plan designs or products. Provides daily coordination of activities related to operations of pharmacy benefit management. Serves as subject matter expert for new initiatives.- Provides daily coordination of activities related to operations of pharmacy benefit management.
- Provides support to staff and coordinates tasks regarding the research, development, implementation and evaluation of programs, projects and initiatives.
- Serves as resource to staff and subject matter expert for assigned initiatives to provide input regarding pharmacy needs, impacts and projects.
- Resolves issues and escalates to management as appropriate; assists management in addressing clinical and contractual issues.
- Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team.
- Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing/making pharmacy claim adjustments as appropriate.
- Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate
- Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate.
- Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.
Hiring Requirements
• High school diploma or GED
• 3+ years of experience in related field.
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Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
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