- 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: - Determine plan membership status on case-by-case basis for both current as well as new enrollments!
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operations expert - clinical decision making - Singapore - beBeeCustomer
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:
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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