Requisition #:

6995

# of openings:

1

Employment Type

Full time

Position Status

Permanent

Category

Non-Bargaining

Workplace Arrangement

Hybrid

Fund

1199SEIU National Benefit Fund

Job Classification

Non-Exempt

Responsibilities

Act as a clinical and operational liaison of the Fund’s Rx benefit between 1199SEIU Benefit Fund members, providers, Utilization Management (UM)vendors, and pharmacies
Access Fund’s UM vendor system in the Medical Benefit Drug Management Program to access and download report of medical drug UM cases
Access Fund’s UM vendor system in the Medical Oncology Program to access and download provider, member, or facility site UM letters of medical oncology cases
Access the Fund’s PBM system to access prescription drug and appeals information
Utilize the Document Management System (DMS) Rx module to prepare, organize and maintain prescription drug inquiries received by fax from providers or members or other Fund Departments
Monitor, screen and respond to incoming emails from Fund Departments to resolve escalated Rx benefit issues by close of business day
Prepare Rx utilization forms in the DMS module and gather clinical documents by accessing UM vendor systems and researching past clinical authorizations
Prepare physician UM benefit determination letters and appeal communications of prescription drug inquiries
Fax provider communications of prescription drug clinical reviews through a secure method that is HIPAA compliant
Verify member eligibility status and eligibility class in Vitech (V3), where applicable
Enter notes in claims processing system (QNXT) of prescription drug inquiries, provider inquiries, and appeals
Post Bulletin Board notices and contribute to BeneFAQs topics related to the Rx benefit
Assist in maintaining the accuracy of the drug benefit content of the Fund’s website by working with Digital Communications
Perform special projects and assignments as directed by management

Qualifications

Associate’s Degree required. Bachelor’s Degree or Pharmacy Technician Certification (CPhT) preferred
Minimum of one (1) years prior work experience in a health care setting such as: retail or mail order pharmacy, physician’s office, outpatient medical facility, Pharmacy Benefits Manager ( PBM) DME supplier or Prior Authorization (PA) Call Center is required
Bilingual language skills are a plus
Excellent knowledge of the Fund pharmacy and medical drug benefits, eligibility rules and regulations