Pharmacy Benefits Specialist - St. Luke's Health Plan - St. Luke's Health System
Boise, ID 83702
About the Job
At St. Luke’s, our dedicated team of Pharmacy Benefits Specialists are critical in providing exceptional, patient-centered care. We strive to foster an environment that embraces our employees' unique strengths, experiences and perspectives which ultimately drives our exceptional, patient-centered care.
Pharmacy Benefits Specialists assist our members in identifying and navigating pharmacy benefits management (PBM) and third-party issues such as prior authorization, step therapy, reviewing denied claims, and processing overrides. Our PBM Specialists work with an interdisciplinary team of pharmacy staff, patient financial advocates, the pharmacy authorization team, clinic staff, and providers; and issue insurance overrides and processes prior authorizations.
What You Can Expect
- Work with a team of Pharmacy Benefits experts, establishing and maintaining collaborative working relationships with pharmacies, members, and providers
- Review and validate the supporting clinical documentation provided by a patient's prescriber against the drug and therapeutic indication for that situation
- Apply knowledge of high-cost specialty medications, the applicable pharmaceutical regulations, and requirements to align member and Health Plan cost containment strategies
- Navigate federal laws that may impact patients from participating in manufacturer copay card programs
- Accurately calculate costs and savings while processing specialty medications
- Provide customer service and explain insurance topics to patients and providers
- Apply working knowledge of insurance plan design and terminology (deductible, max out of pocket, co-insurance, etc.)
- Interpret medical terminology and accurately process prior authorization requests for medications under the pharmacy benefits
- Facilitate resolutions to issues involving claims adjudication, member concerns, and provider communications
- Address questions from third-party payers and medical staff regarding medication issues and reimbursement
Qualifications
- High School diploma or equivalent
- One (1) year of experience
- Valid Idaho Pharmacy Technician License
Preferred Qualifications
- Three (3) + years' experience
- Certified Pharmacy Technician
- PBM experience
Why St. Luke's:
At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.