Note: The job is a remote job and is open to candidates in USA. Allied Benefit Systems is hiring a Specialty Rx Administrator to coordinate pharmacy and medical prior authorization requests between pharmacies, prescribers, members, and vendors. The role supports specialty carve-out programs, single case agreements, claims processing, and related internal and external communications.

Responsibilities

• Collect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacity
• Arrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member’s associated QicLink page
• Execute, manage, and provide on-going support of single case agreements
• Assist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendors
• Submit member referrals to third-party vendors managing specialty carve-out programs
• Serves as liaison for external vendors when implementing specialty carve-out programs
• Reviews current and newly requested vendor plan language to understand impact with governmental regulations
• Ensure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycle
• Collaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendor
• Management of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teams
• Other duties as assigned

Skills

• Bachelor's degree or equivalent work experience required
• At least 5 years of professional experience including comprehension of pharmacy and medical benefits, specialty medications, j-codes and their administration, limited distribution drugs as well as specialty pharmaceutical manager selection required
• Prior authorization experience required
• Excellent verbal and written communication skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Strong analytical and problem-solving skills
• Ability to prioritize tasks and to delegate them when appropriate
• Ability to function well in a high-paced and at times stressful environment
• Proficient with Microsoft Office Suite or related software
• Knowledge of medication use in RA, transplant, Hepatitis C, infectious disease, and or oncology preferred

Benefits

• Medical, Dental, Vision, Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• A Technology Stipend
• Remote-friendly culture offering flexibility and the comfort of working from home

Company Overview