What are the responsibilities and job description for the Pharmacy Coordinator position at CSTS Customer Service and Technology Solutions LLC?
Job Title: Pharmacy Coordinator – Medicare Part D
Position Summary:
We are seeking a detail-oriented Pharmacy Coordinator to support the daily operations of our Medicare Part D Prescription Drug Program. This role ensures compliance with CMS and NCQA requirements while managing claims adjudication, coverage determinations, call log reviews, grievances, and other compliance-related activities. You will collaborate with internal teams and PBM partners to resolve issues, meet deadlines, and deliver accurate, high-quality Part D benefits to our members.
Key Responsibilities:
- Review coverage determination and redetermination case files for accuracy and compliance.
- Monitor call center logs and adjudication processes to ensure CMS and NCQA standards are met.
- Verify prescription coverage aligns with benefit design and formulary requirements.
- Collaborate with PBM and internal teams to implement clinical initiatives and improve member outcomes.
- Conduct monthly formulary and Explanation of Benefits audits; prepare quarterly summaries.
- Respond to inquiries from Member Services and Grievance teams regarding Part D issues.
- Provide real-time feedback to PBM through audits and calibration calls.
- Ensure timely processing of all Part D functions and compliance with regulatory timelines.
- Perform additional duties and projects as assigned.
Qualifications:
- High School Diploma required; Associate or Bachelor’s degree preferred.
- Pharmacy technician experience preferred.
- 2–4 years of experience in Medicare Part D within Managed Care or PDP plan preferred.
- Knowledge of PBM operations, pharmacy benefit design, and Medicare compliance required.
- Proficient in Microsoft Office (Excel, Word, PowerPoint) and PBM systems.
- Strong attention to detail, organizational skills, and ability to manage multiple priorities.
Why Join Us?
- Opportunity to make a meaningful impact in Medicare compliance and member care.
- Collaborative team environment with growth potential.
Pay: $22.00 per hour
Expected hours: 40 per week
Work Location: Remote
Salary : $22