Job Description

Pharmacy Coordinator – Bilingual Spanish

Position: Pharmacy Coordinator
Language Requirement: Bilingual – English/Spanish
Industry: Healthcare / Health Insurance / Pharmacy Benefits Management

About the Opportunity

We are seeking a Bilingual Pharmacy Coordinator (English/Spanish) to support pharmacy call center operations for a leading healthcare organization.

The ideal candidate will have a strong understanding of Pharmacy Benefits Management (PBM), prescription drug benefits, prior authorizations, and pharmacy claims processing, along with excellent communication and customer service skills.

In this role, you will serve as a key resource for pharmacy network providers, physicians, and internal teams, helping resolve medication coverage questions, prescription claim denials, and pharmacy benefit issues while ensuring compliance with state and federal regulations.

Key Responsibilities

• Provide front-line support and guidance to pharmacy call center staff, ensuring efficient and accurate delivery of pharmacy services.

• Respond to physician and pharmacy network provider inquiries regarding oral, injectable, and infusion medications.

• Review and assist with prior authorization requests, non-formulary medication exceptions, and prescription drug claim edits.

• Review member prescription claims history to help evaluate medical necessity and medication coverage exception requests.

• Assist pharmacy providers with denied point-of-sale (POS) prescription claims, identifying issues and helping facilitate resolution.

• Support coordination of benefits (COB) processes and procedures for pharmacy claims.

• Interpret and apply health plan pharmacy benefit designs, formulary requirements, and medication coverage guidelines.

• Monitor adherence to state and federal requirements governing prescription drug benefits.

• Educate pharmacy network providers on pharmacy benefit policies, claim processing requirements, and appropriate procedures.

• Collaborate with internal pharmacy teams and network providers to resolve complex medication coverage and claims-related issues.

• Deliver professional, accurate, and compassionate service in a fast-paced call center environment.

Required Qualifications

• Bilingual proficiency in English and Spanish is required.

• Understanding of Pharmacy Benefits Management (PBM) and prescription drug benefit programs.

• Knowledge of pharmacy claims processing, medication coverage, formularies, and prior authorization procedures.

• Ability to interpret prescription drug claim denials and assist with resolution.

• Strong verbal and written communication skills.

• Excellent customer service, analytical, and problem-solving abilities.

• Ability to work effectively with physicians, pharmacies, and healthcare professionals.

• Strong attention to detail and ability to manage multiple priorities in a fast-paced environment.

Preferred Qualifications

• Previous experience in a healthcare, health insurance, pharmacy, or PBM call center.

• Familiarity with Medicare, Medicaid, or commercial pharmacy benefit programs.

• Experience reviewing pharmacy claims history and medication exception requests.

• Knowledge of coordination of benefits and point-of-sale prescription claim processing.

• Experience working with pharmacy network providers and medical offices.

Required Assessment

Candidates must complete the "Pharmacy Coordinator" Glider assessment.

Recruiters must ensure that candidates complete the assessment and include the link to their completed Glider assessment on their resume before submission.

Why This Opportunity?

This position offers the opportunity to support patients, healthcare providers, and pharmacy networks by helping ensure timely access to appropriate prescription medications. You will play an important role in resolving pharmacy benefit issues, improving service delivery, and supporting quality healthcare outcomes.

If you are bilingual in English and Spanish, have experience with pharmacy benefits, and enjoy helping healthcare providers navigate prescription coverage and claims issues, we encourage you to apply!