Position Overview: Coordinate application of pharmacy services and benefits as an integral contributor on the pharmacy team. Handle pharmacy-related inquiries and communicate benefit determinations.  Provide pharmacy services helpdesk support to pharmacies, providers, and members. Perform pharmacy authorization and claim processing services. 

This position will work Monday through Friday, 8am-5pm - This is not in a retail environment requiring evening/weekend shifts!

Essential Responsibilities:

• Act as principal contact regarding drug authorizations and system overrides. Help to resolve pharmacy services and benefits inquiries through skillful knowledge of the pharmacy claims, medical claims, and utilization management platforms.
• Initiate clinical review and decision-making of authorization requests under the guidance of clinical pharmacists.
• Effectively communicate and collaborate in a clear and concise manner to internal and external partners, including translating clinical and technical industry jargon to appropriate audiences.
• Function as liaison with pharmacy benefit manager, pharmacies, physicians, and others in order to apply benefits, and assist with pharmacy benefit determinations.
• Consult with clinical pharmacists and other staff in determining coverage for pharmacy-related services and pharmaceuticals.
• Prepare and process member-submitted pharmacy claims in the pharmacy benefit manager’s claims processing system.
• Ensure all coverage determinations are processed in a timely and accurate manner, consistent with Commercial, Medicare & Medicaid regulatory requirements and department policies.
• Serve as primary resource to member and providers for pharmacy questions related to the health plan and in navigating through the health systems.

Work Experience: Minimum two years work in a Pharmacy. Demonstrated ability to work efficiently and effectively with a high attention to detail.

Education, Certificates, Licenses: Minimum high school diploma. Unrestricted pharmacy technician license by the Board of Pharmacy and previously passed National Pharmacy Technician certification exam required. Maintain continuing education requirements for license renewal.

Knowledge:

• Good understanding of Medical Terminology required. Familiarity of CPT/ICD-10 codes, home infusion therapies, and specialty medications helpful. Microsoft Office products including Word, Excel, and Outlook.
• Ability to work under time sensitive deadlines. Ability to prioritize responsibilities, diplomatically, handle demanding situations and manage workload with direct supervision. Demonstrate organizational and time management skills.
• Ability to understand and interpret Federal and State specific regulatory requirements helpful. Ability to communicate effectively across all levels of the business on a consistent basis.

Please submit resume for consideration. 

Provide excellent customer service primarily by telephone to all customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.

**Temp to hire opportunity!**

Essential Responsibilities:

• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
• Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
• Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized.
• Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
• Document calls in a clear and consistent manner in computer system.
• Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
• Relay information to appropriate departments and personnel using established communication channels and procedures.
• Make outbound calls to members as necessary dependent upon current outreach campaign.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Be aligned with company values.
• Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred.

Education, Certificates, Licenses: High School Diploma or equivalent required.

Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills.

Provide excellent customer service primarily by telephone to all customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.

**Temp to hire opportunity, and is remote out of Idaho or Oregon**

Essential Responsibilities:

• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
• Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
• Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized.
• Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
• Document calls in a clear and consistent manner in computer system.
• Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
• Relay information to appropriate departments and personnel using established communication channels and procedures.
• Make outbound calls to members as necessary dependent upon current outreach campaign.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Be aligned with company values.
• Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred.

Education, Certificates, Licenses: High School Diploma or equivalent required.

Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills.

The HR Generalist is responsible for the scope, structure & adherence of company HR policies and procedures that affect the well-being of all employees while safe guarding the company’s best interests and legal responsibilities at their Mascot, TN plant.

Specific Duties

1. Oversees all duties related to hourly payrolls.
2. Regularly audits all hourly personnel employee files for compliance.
3. Participates in developing HR strategies that support the company’s business plans.
4. Maintains, creates & updates Employee Handbook policies & guidelines.
5. Participates, develops & monitors company safety policies, procedures and record keeping.
6. Recommends hiring practices of new employees on all levels.
7. Oversees drug screening adherence, policies and record keeping as applicable.
8. Assists President & General Manager in coordinating health insurance renewals, administers companywide health benefits and participates in benefits presentations when practical.
9. Ensures compliance in the event of an employee termination or voluntary quit.
10. Manages all Workers Compensation injuries, processes paperwork and monitors medical care to assure adequate treatment and expeditious return to normal job duties.
11. Drafts & updates job descriptions for all positions throughout the company.
12. Knowledgeable on all current State and Federal Labor laws, required postings and reporting.
13. Assists the Operations Managers on safety issues, safety meetings, safety procedures and OSHA/EPA polices & requirements.
14. Ensures compliance with Federal Motor Carrier Safety Administration (FMCSA) & Biennial Inspection of Terminals (BIT) requirements for the JPL truck drivers.
15. Monitors employee training to ensure certifications are current and all training is in compliance with state and federal requirements [i.e. Harassment, Forklift, Fire Extinguisher, CPR].

Reporting Relationships

1. Reports directly to the President of the company.
2. The direct voice / advocate of all employees to management.
3. Assists all managers on interviews, personnel relations, disciplinary decisions and terminations.
4. Maintains open communication with the company’s Manufacturing Manager concerning HR policies, procedures or issues that are to be addressed.
5. Keeps the General Manager up to date on changes in labor and medical insurance laws and how those changes may affect company financials.

Requirements

1. Preferred degree in Human Resources Management or related field and/or equivalent 3+ years of prior Full-Time Human Resource experience
2. Excellent communication skills
3. Planning, prioritization and organizational skills
4. Employee advocate, results driven & team player

We are seeking a detail-oriented and customer-focused Healthcare Administrative Support Specialist to provide administrative, data entry, and customer service support in a fast-paced healthcare environment. This role is responsible for maintaining accurate records, assisting patients and internal teams, managing documentation, and supporting daily office operations while ensuring confidentiality and compliance with company policies and healthcare regulations.

Key Responsibilities

• Provide administrative support to healthcare teams and office staff.
• Perform accurate data entry and maintain electronic records and databases.
• Answer incoming phone calls, emails, and customer inquiries in a professional and timely manner.
• Schedule, confirm, and update appointments as needed.
• Verify and update patient, member, or client demographic information.
• Process forms, referrals, authorizations, and other administrative documents.
• Scan, file, and organize electronic and paper records while maintaining data accuracy.
• Resolve routine customer service inquiries and escalate complex issues to the appropriate department.
• Maintain confidentiality of sensitive information in accordance with HIPAA and company policies.
• Assist with reporting, correspondence, and general office administration.
• Collaborate with cross-functional teams to ensure efficient workflow and high-quality service.
• Support additional administrative projects and operational tasks as assigned.

Qualifications

• High school diploma or equivalent required; associate degree preferred.
• One (1) or more years of experience in administrative support, customer service, data entry, or office administration.
• Healthcare experience is preferred but not required.
• Strong computer proficiency, including Microsoft Office Suite and the ability to learn new systems quickly.
• Excellent verbal and written communication skills.
• Strong organizational skills with exceptional attention to detail.
• Ability to prioritize multiple tasks in a fast-paced environment.
• Professional demeanor with a strong customer service focus.
• Ability to handle confidential information with discretion.