Representative, Pharmacy
1 week ago
Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
Essential Job Duties:
- Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, and standards.
- Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
- Explains point-of-sale claims adjudication, state, and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
- Assists with clerical tasks and other day-to-day pharmacy call center 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 members and providers with initiating verbal and written coverage determinations and appeals.
- Records calls accurately within the pharmacy call tracking system.
- Maintains established pharmacy call quality and quantity standards.
- Interacts with appropriate primary care providers to ensure member registry is current and accurate.
- Supports pharmacists with completion of comprehensive medication reviews (CMRs) through pre-work up to case preparation.
- Proactively identifies ways to improve pharmacy call center member relations.
Required Qualifications:
- At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
- Excellent customer service skills.
- Ability to work independently when assigned special projects.
- Ability to multi-task applications while speaking with members.
- Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
- Ability to meet established deadlines.
- Ability to function independently and manage multiple projects.
- Excellent verbal and written communication skills.
- Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
Preferred Qualifications:
- Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license.
- Health care industry experience.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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