Blue Cross Blue Shield Of Tennessee

Clinical Pharmacy Specialist

Blue Cross Blue Shield Of Tennessee • $85K — $100K *
US-AnywhereRemote in Chattanooga, TN
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • High School Diploma or equivalent.
  • 2 years of pharmacy experience required.
  • National Certification as Pharmacy Technician (PTCB).
  • Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
  • Strong interpersonal, organizational, and communication skills.

Responsibilities

  • Enter authorizations and test claims into the pharmacy benefit system.
  • Handle incoming and outgoing phone calls from providers and members for coverage determinations.
  • Monitor and respond to emails and inquiries regarding pharmacy reviews and claims.
  • Review daily pharmacy reports for appropriate claims processing.
  • Assist with departmental audits and quality improvement activities.

Benefits

  • Opportunity to develop specialized knowledge in coverage review.
  • Flexible working hours with a Monday-Friday schedule, and potential for evening and weekend work on rotation.
  • Collaborative team environment.
  • Impactful role in member care and health outcomes.
Full Job Description
In this role, you will support Medicare and D-SNP coverage review activities, helping ensure members receive timely and appropriate access to pharmacy benefits and services. You'll work closely with pharmacists and healthcare providers to build and manage cases, contributing to important coverage determinations that directly impact member care and health outcomes.

You will contribute to team success by balancing independent work with collaboration across the pharmacy team. This role offers the opportunity to develop specialized knowledge in coverage review while serving as a key resource in the review process. You'll engage with providers, manage multiple priorities, and play an important part in delivering high-quality service to both members and providers.

To be successful in this position, you'll bring strong computer and organizational skills, attention to detail, and the ability to navigate complex information in a remote environment. Ideal candidates will have experience in Medicare, Medicaid, retail pharmacy, or managed care settings. Previous experience with coverage review processes will help support a smoother transition into the role.

Note:
  • Schedule: Monday-Friday 8AM-6PM EST, must be available to work nights and weekends on a rotating basis

Job Responsibilities
  • Enter authorizations and test claims into the pharmacy benefit system to ensure appropriate claim adjudication.
  • Handle incoming and outgoing phone calls from providers and/or members/members representatives to assist in completing coverage determinations and appeals.
  • Monitor and answer emails and FACETs inquiries from internal customers regarding pharmacy reviews, appeals, claims issues, etc.
  • Review daily pharmacy reports to ensure appropriate claims processing.
  • Assist with departmental audits and quality improvement activities.
  • May be required to work evenings, holidays and weekends to ensure adequate coverage to meet the business needs including on call rotations


Job Qualifications

Education
  • High School Diploma or equivalent


Experience
  • 2 years - Pharmacy experience required


Skills/Certifications
  • National Certification as Pharmacy Technician (PTCB)
  • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
  • Must be a team player, be organized and have the ability to handle multiple projects
  • Excellent oral and written communication skills
  • Strong interpersonal and organizational skills
  • Proven decision making and problem solving skills
  • Ability to work independently and with minimal supervision
  • Knowledge in Medical/Pharmacy terminology


Number of Openings Available
1

Worker Type:
Employee

Company:
BCBST BlueCross BlueShield of Tennessee, Inc.

About Blue Cross Blue Shield Of Tennessee

BlueCross BlueShield of Tennessee is a non-profit health insurance company that provides coverage to more than 3.5 million people. The company was founded in 1945 and is headquartered in Chattanooga, Tennessee. BlueCross BlueShield of Tennessee offers a variety of health insurance plans, including individual and family plans, Medicare plans, and employer-sponsored plans. The company is committed to improving the health and well-being of its members and the communities it serves.
Learn more about Blue Cross Blue Shield Of Tennessee
Size
5,000 employees
Industry
Healthcare
Founded
1945
* Ladders Estimates

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