Pharmacy Help Desk Specialist

AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

Under the supervision of the Customer Support Leadership, the Customer Support Specialist is responsible for answering calls from our clients and providing timely and accurate responses in a professional and courteous manner. This position works with internal and external clients which include: members, clinicians, pharmacies, plan sponsors and other departments within the company.

This position also assists with various internal tasks that ensure a high level of overall client satisfaction. On the job training will be provided.

Pharmastar (an anewhealth company) is a Pharmacy Benefits Manager (PBM) for Medicare Part D Plans and PACE Plans.

Responsibilities

• Answer telephone inquiries in a pleasant, professional and efficient manner assuring exceptional customer service.
• Document all incoming calls and dialogue in the claims adjudication software.
• Educate clients on plan policies, benefits and procedures.
• Resolve client drug benefit concerns of a medical, financial, or technological nature.
• Initiate and facilitate prior authorization requests.
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
• Participate in on-call rotation.
• Accept other duties as assigned; including but not limited to: direct member reimbursement, processing, manual claims, reporting and researching rejected claims.
• Attend department and company meetings and educational programs upon request.
• Ensures that HIPAA guidelines are followed in every communication with clients.
• Interest in learning new tasks for development purposes.

Qualifications

• Associate's degree preferred. High School Diploma or equivalent required.
• 1 year of customer service/member service experience in a call center or similar, required.
• Health care industry experience, a plus.
• CPhT (Certified Pharmacy Technician) certification, a plus.
• Experience in a pharmacy support role, a plus.
• Knowledge of plan and benefit structures and Medicare guidelines, a plus.

Skills, & Abilities

• Knowledge of pharmacology and pharmacological terms.
• Excellent communication skills and professionalism when working with clients.
• Ability to solve problems under pressure by making immediate decisions while on the phone.
• Detail oriented and able to prioritize workload.
• Strong computer skills including using word processors, spreadsheets, and database software.

Schedule

• This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.

Physical Demands & Requirements

• Communicates by way of the telephone with providers, participants, customers, and vendors; majority of the work day is spent communicating on the telephone
• Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
• Remains stationary for extended periods of time
• Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
• Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
• Occasional reaching to retrieve shelved items
• Occasional bending/stooping

Work Environment

• This job operates in a professional office environment with a conversational noise level.
• No substantial exposure to adverse environmental conditions is expected.
• Moderate pressure to meet scheduled appointments and deadlines

AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.