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Job Field: Legal Jobs
Location: PORTLAND, WA
Salary: $-
Job Type: Full Time

JOB SUMMARY:

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               <td align="left"><font style="font-size: 100%;">***Registration in iMatchSkills required for referral to this position; go to www.imatchskills.com***    REQUIREMENTS:  *2 years of experience working in retail pharmacy or health insurance plan; OR any work experience and/or training that would likely provide the ability to perform the essential functions of the position.    JOB DUTIES:  *Maintain confidentiality within HIPAA regulations and function on need to know principles  *Respond to pharmacy benefit inquires in an accurate and timely manner to members, members representatives, providers, and company staff  *Document all customer service activities according to organization requirements  *Follow policies and procedures to answer questions from members, providers and company staff regarding claims processing as it pertains to the Company pharmacy benefits.  *Follow policies and procedures to determine a resolution to pharmacy claims processing requests or triage to other company staff for assistance.  *Sort in-coming faxes and distribute according to assignments  *Assist with data entry into the claims processing system, document managements systems, databases and spreadsheets as assigned.  *Verify member's plan eligibility and applicable pharmacy benefit  *Educate members, providers and pharmacies and company staff about the company's formularies and pharmacy benefit policies   *Assist members and providers with the PA, formulary exception and coverage determination process. Follow policy & procedures to facilitate a resolution for prior authorization, formulary exception and coverage determinations requests. Notify providers or providers staff of prior authorization and formulary exception decisions  *Explain pharmacy appeal and grievances provisions and process to members, providers and company staff  *Assist the Appeals & Grievance Coordinators, Pharmacists, and Quality Improvement Coordinators with processing pharmacy benefit appeals and grievances  Under the supervision of a pharmacist and the operations supervisor, assist company on pharmacy benefit projects including, but not limited to:  *Participate in Accelerated Process Improvement Teams or PDSA cycles    EMPLOYER' COMMENTS: Pass a pre-employment background check.   Preference will be given to individuals who have experience with managed care and pharmacy benefit management and/or who have demonstrated leadership in roles or responsibilities with current or past positions or projects.   Position may close at any time.   We're an Equal Employment Opportunity Employer.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               </font></td>
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KEY REQUIREMENTS:

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24 Months