Customer Service Representative, Medicare Pharmacy
4 weeks ago
Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws.
Key Responsibilities:- Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.
- Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
- Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.
- Assists with clerical services/tasks and other day-to-day operations as delegated.
- Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
- Assists member and providers with initiating oral and written coverage determinations and appeals.
- Records calls accurately in call tracking system.
- Maintains specific quality and quantity standards.
- High School Diploma or GED equivalent.
- 1-3 years of call center or customer service experience.
- Preferred Education: Associate degree.
- Preferred Experience: 3-5 years; healthcare industry experience preferred. National pharmacy technician certification.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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