SENIOR PHARMACY COORDINATOR

Summary/Objective: The Senior Pharmacy Coordinator supports the Pharmacy Manager in the administration and day-to-day operations of the Pharmacy Department, with responsibility for complex member issues, appeals administration, pharmacy operations, reporting and analytics, and departmental initiatives. The position independently coordinates assigned activities, identifies issues requiring further review, and helps ensure pharmacy programs are administered accurately, efficiently, and in accordance with established procedures and Plan provisions. Essential Functions: Member Support Handle member phone calls, participate in member events, and meet with members as needed. Manage member inquiries and issues from start to finish, ensuring appropriate follow-through, timely communication, and resolution. Collaborate and communicate with internal departments, vendors, providers, pharmacies, and other stakeholders to obtain information and address inquiries. Maintain a working knowledge of Plan Documents, Schedules of Benefits, coverage policies, and related pharmacy program materials. Appeals Administration Request, obtain, and follow up on medical records and other supporting documentation. Submit appeal materials for clinical review and monitor progress through completion. Prepare appeal summaries and supporting materials for Manager review. Maintain appeal tracking logs and case records, ensuring activities, determinations, status updates, and timelines are accurately documented. Pharmacy Operations Review Employer Group Waiver Plan (EGWP) reports and monitor enrollment and disenrollment activity. Track Medicare Prescription Payment Plan activity, including member outreach and communications. Review overpayment logs and support recovery efforts, including member letters and invoices. Maintain departmental tracking logs and develop and enhance tracking and monitoring tools. Participate in and coordinate assigned activities related to benefit changes, projects, and implementations. Other duties as assigned. Reporting and Analytics Review Prior Authorization reports to identify unusual activity, potential discrepancies, trends, and opportunities for further analysis. Collect, validate, and organize data from vendors, internal departments, and other sources. Analyze data and develop reports, summaries, presentations, dashboards, and other materials to support management, department operations, and ongoing reporting activities. Communications Prepare mail merge letters, member mailings, and other pharmacy communications as needed. Education and Length of Experience: Education Bachelor’s degree in related field preferred. Experience Three to five years of experience in a retail pharmacy, specialty pharmacy, PBM, health plan, or other pharmacy-related settings. Experience working with pharmacy benefits, including prior authorizations, pharmacy claims processing, formularies, utilization management programs, and Medicare Part D. Experience handling calls and researching and resolving member, provider, and pharmacy inquiries. Advanced proficiency in Microsoft Excel and PowerPoint. Experience with Salesforce, Microsoft Teams, Zoom, Outlook, or similar business applications. Specialized skills/technical knowledge required: Strong knowledge of pharmacy terminology, commonly prescribed medications, specialty medications, and their general uses. Strong verbal and written communication skills, with the ability to communicate professionally, effectively, and courteously. Highly organized, detail-oriented, and accurate in completing work. Ability to prioritize and manage multiple responsibilities while ensuring timely follow-through and meeting deadlines. Adaptable, dependable, and willing to learn new processes and systems. Strong problem-solving, analytical, and teamwork skills.