Pharmacy Specialist I
$43.9k/y-$58.8k/y
a day ago
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OnsiteFull-timeEntry
Summary
Horizon Blue Cross Blue Shield of New Jersey is seeking a Pharmacy Specialist I to join their team in Hopewell, NJ. The role involves receiving and processing prior authorization requests for pharmacy services and ensuring compliance with regulatory standards.
About the Role
As a Pharmacy Specialist I, you will be responsible for telephonic interactions with members, physicians, and pharmacies regarding pharmacy eligibility and coverage determinations. You will engage with healthcare professionals to facilitate formulary compliance and optimize dispensing practices. Your duties will include capturing clinical information for prior authorization requests, processing complaints and appeals, and identifying potential fraud and abuse. You will also assist in the day-to-day operations of the pharmacy department and support various clinical programs.
About You
Required:
- High School Diploma/GED required.
- Minimum of two (2) years experience as a Pharmacy technician.
- National Pharmacy Technician Certification (PTCB or ExCPT) required.
Preferred:
- Minimum of two (2) years experience in third party prescription program claim adjudication.
- Experience in customer service/service quality initiatives.
Benefits
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company. Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ. Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
Hopewell, NJ