Pharmacy Coordinator

About the role

The Pharmacy Coordinator leads front‑line staff in a high‑volume pharmacy call center, ensuring efficient delivery of services and compliance with state and federal drug benefit designs. This role serves as the primary reviewer for physician and provider inquiries, medication requests, and claim edits.

Key responsibilities

• Guide and support call‑center staff to meet performance standards.
• Monitor adherence to health‑plan drug benefit designs and federal regulations.
• Respond to physician and pharmacy network inquiries about oral, injectable, and infusion medication requests.
• Process drug claim edits, prior authorizations, and evaluate medical necessity for non‑formulary requests.
• Review member claim histories to determine eligibility and necessity of medication exceptions.
• Collaborate with pharmacy network providers to resolve denied point‑of‑sale claims and coordinate benefits.

Required profile

• High School Diploma or GED.
• 3‑5 years of customer service experience, preferably in a pharmacy or healthcare setting.
• Strong knowledge of pharmacy operations, pharmaceutical products, and pharmacy benefits management.
• Ability to identify barriers and solve problems effectively.

Required skills

• Proficiency with the Microsoft Suite (Word, Excel, Outlook, PowerPoint).