Pharmacy Operations Analyst

Job Summary

Serving as the primary contact for providers, the full-time Pharmacy Operations Analyst will manage authorization requests for retail pharmacy, home infusion, and medical utilization management, while supporting inquiries from various business areas remotely.

Key responsibilities:

• Receive, process, and archive provider authorization requests accurately using multiple computer systems
• Review member eligibility and claims history to provide information to internal and external clients
• Communicate determinations to providers and support new clinical program implementations

Required qualifications:

• Minimum of a High School diploma; Associate or Bachelor's degree preferred
• Proficiency in MHK and PBM Systems preferred
• Previous experience in a managed care or pharmacy environment preferred
• Prior experience assisting members and/or providers with telephone inquiries
• Strong data entry skills and attention to detail required