Pharmacy Benefits Specialist

ExactCare Pharmacy; Cleveland (OH); Remote; USD 42,000 - 60,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with company match

Paid time off & holidays

Job summary

AnewHealth is seeking a Customer Support Specialist to answer calls from clients and provide accurate, courteous assistance. You will educate on plan benefits, process prior authorizations, and collaborate on JIRA tickets for billing, prescriptions, and NDC issues.

Remote work with standard EST hours and a focus on HIPAA compliance and excellent client service. Experience in healthcare and Medicare guidelines is preferred, with a commitment to professional communication.

Qualifications

• Associate’s degree or equivalent combination of education or work experience.
• 3+ years of customer service experience in a call center or similar.
• 2+ years in healthcare.
• Knowledge of plan structures and Medicare guidelines.

Responsibilities

• Answer telephone inquiries in a pleasant, professional, and efficient manner.
• Document all calls and dialogue in the claims adjudication software.
• Educate clients on plan policies, benefits, and procedures.
• Initiate and facilitate prior authorization requests.
• Submit JIRA tickets for claims, prescriptions, pricing, and NDC issues.
• Ensure HIPAA compliance in all communications.

Skills

Customer service

Communication skills

Problem solving

Detail oriented

Education

Associate's degree or equivalent

CPhT Certification

Tools

JIRA

Microsoft Office

Job description

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 DetailsThe 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.ResponsibilitiesAnswer 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.Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets.Review after hours calls log-complete any follow up as needed.Submit JIRA tickets for compound prescriptions.Submit JIRA tickets to resolve NDC issues (pricing issues, missing NDCs)Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.Accept other duties as assigned; including but not limited to direct member reimbursement, processing, manual claims, reporting, and researching rejected claims.Ensures that HIPAA guidelines are followed in every communication with clients.Embody AnewHealth’s Core Values in all communications and interactions.Other duties as assigned.The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.Qualifications: These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.EducationRequired: Associate’s degree or equivalent combination of education or work experience.Preferred: CPhT (Certified Pharmacy Technician) Certification.ExperienceA minimum of 3 years of experience in customer service/member service in a call center or similar.A minimum of 2 years of experience in the healthcare industry.A minimum of 2 years of experience in a pharmacy support role.Knowledge of plan and benefit structures and Medicare guidelines.Skills & AbilitiesKnowledge 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 be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Scheduled hours 11:30am to 8:00pm Eastern Standard Time.Travel: Travel may be required for special organization or department events, department team meetings, trade shows, conferences, and other client engagements.This is a remote position.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.