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Pharmacy Representative
1 month ago
Job Overview
Molina Healthcare is seeking a highly skilled Pharmacy Representative to join our team. As a Pharmacy Representative, you will play a critical role in ensuring that our pharmacy benefit programs are operating effectively and efficiently.
Responsibilities
* Handle and record inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.
* Provide coordination and processing of pharmacy prior authorization requests and/or appeals.
* Explain Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.
* Assist with clerical services/tasks and other day-to-day operations as delegated.
* Effectively communicate plan benefit information, including but not limited to, formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
* Assist member and providers with initiating oral and written coverage determinations and appeals.
* Record calls accurately in call tracking system.
* Maintain specific quality and quantity standards.
Requirements
* 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. We are an Equal Opportunity Employer (EOE) M/F/D/V.
