Pharmacy Benefits Specialist

Company: Upperline Health
Location: Nashville
Posted on: November 22, 2021

Job Description:

About UsUpperline Health launched in 2017 and is the nations leading comprehensive and coordinated lower extremity healthcare organization. Upperline Health provides the highest quality integrated health services to more patients in need through a skilled and compassionate team. We specialize in targeting patients at risk of developing complications and intervening earlier with an innovative care management approach to prevent more serious consequences. Upperline Health is based out of Nashville, TN and currently has practices in Alabama, California, Florida, Georgia, Indiana, and Tennessee.BenefitsComprehensive benefit options include medical, dental and vision, 401(k) and PTO.About the Pharmacy Benefits Specialist RoleUpperline Health is seeking a Pharmacy Benefits Specialist to adjudicate pharmacy claims for patients who are receiving their medication in our clinics. This role will be based in the office connected to our compound pharmacy on Metroplex Drive near Nashville International Airport.Recent studies have indicated that 40% of patients never pick up their prescriptions and are thus non-adherent to their care plans. Upperline Health operates in-office pharmacies in its clinics to offer patients the most convenient option for obtaining their prescriptions. Upperline is now in network with several large pharmacy benefit managers so that patients can use their pharmacy benefits to pick up their prescriptions. This role will centrally adjudicate all pharmacy claims for medication dispensed in our clinics. A successful candidate must thrive in a fast-paced environment and demonstrate compassion for patients, have great attention to detail, and communicate well with team members. Responsibilities will be varied, and candidates should be a multitalented, flexible problem solver who is also eager to execute an important process accurately and consistently. What you will doUse Upperline's pharmacy software to manage a centralized queue of prescriptions from all of Upperline's locationsAdd a patient's pharmacy benefits to their profile and transmit claimsProcess all prescriptions through the patients' pharmacy benefitsCommunicate adjudication outcome when necessary with front desk staff in the clinic who are dispensing medication to patients; also available to answer any questions from patients about their benefits as it relates to their prescriptionManage prior authorizations for prescriptions which require themWork with call centers for the pharmacy benefits managers (PBMs) when necessary to obtain a patient's pharmacy benefit informationManage network contracts with PBMs to ensure that Upperline continues to be able to process claimsQualifications of the Pharmacy Benefits SpecialistBackground in pharmacy adjudication preferredExperience with MDScripts software is a plusAssociates or Bachelors degree preferredMotivated to own, improve, and execute on processesSelf-starter with an entrepreneurial spirit, demonstrated problem solving skills, and flexibility to work in a fast-pace and evolving environmentExcellent organizational skills, ability to multi-task and a proven work ethicQuick learner who is team-oriented and willing to dive in and get her/his hands dirtyPossesses a strong customer service orientation and a desire to learn from and assist othersAbility to communicate in an open and honest way that quickly builds trust and respectEmbodies Upperlines values of empathy, collaboration, and respectCompensationCompensation is commensurate to compensation for similar positions in the region and based on prior training and experience.Job Type: Full-time#rpharmacybenefits #pharmacisttech #pharmacy #pharmacist #adjudication #MDScripts #prescriptionPM21Powered by JazzHRPI154363889

Keywords: Upperline Health, Nashville , Pharmacy Benefits Specialist, Healthcare , Nashville, Tennessee