operations expert - clinical decision making - Singapore - beBeeCustomer

    beBeeCustomer
    beBeeCustomer Singapore

    2 weeks ago

    Job title: Pharmacy Operations Specialist

    Description

    Pharmacy Operations Specialist


    The role of Pharmacy Operations Specialist involves supporting the pharmacy utilization management programs, processing prior authorization requests and providing customer service to internal and external parties.


    Main Responsibilities:


    • Receive, process and review all prior authorization requests received through fax, phone or electronic systems in accordance with regulatory requirements.

    • Avoid claims denials by properly applying clinical policy criteria to reviews of prior authorization requests.

    • Analyze member eligibility data using PBM software to inform clients via telephone or email. Enter accurate information into system according to regulatory standards for both claim history & pharmacy program details.
      The following bullet points highlight additional responsibilities: 
    1. Determine plan membership status on case-by-case basis for ​both current as well as new enrollments!

    In this capacity you will be communicating determinations directly with members/providers where relevant information was missing upon initial request submission date seen from applicant pool searching online before making first call-out attempt going towards them afterwards!


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