Pharmacy Customer Service Rep (Remote)

Molina Healthcare; Town of Florida (NY); Remote; USD 19,000 - 33,000; Full time

Job summary

Molina Healthcare is hiring several Pharmacy Customer Service Representatives. These positions are remote and handle Pharmacy UM / Prior Authorization calls and services for Medicaid and Marketplace members. The team focuses on first call resolution and delivering a positive member experience.

Shift times are Monday through Friday, with several time options depending on business needs. The role emphasizes customer service, accuracy, and collaboration with providers and pharmacists.

Qualifications

• At least 1 year related experience in call center or customer service.
• Excellent customer service skills.
• Ability to multi-task while speaking with members.
• Ability to work independently on special projects.
• Proficiency with Microsoft Office and Excel.

Responsibilities

• Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies.
• Handles and records calls in accordance with policies and CMS/NCQA guidelines.
• Coordinates and processes pharmacy prior authorization requests and appeals.
• Explains policies and guidelines to providers, members and pharmacies.
• Records calls accurately within the pharmacy call tracking system.
• Maintains call quality and quantity standards.
• Assists with clerical tasks and day-to-day call center operations.
• Supports pharmacists with medication reviews.

Skills

Customer service

Communication

Multitasking

Independent work

Team collaboration

Tools

Microsoft Office

Excel

Job description

Molina Healthcare is hiring for several Pharmacy Customer Service Representatives. These positions are remote.

This team handles the Pharmacy UM / Prior Authorization calls and services external calls from providers with Medicaid and/or Marketplace members. Our agents assist with all Medicaid and Marketplace member Pharmacy-related calls. This is a pharmacy call center environment focused on first call resolution and the member's experience.
Shift times will be Monday through Friday 1PM to 930PM EST and 10AM to 630PM PSTall dependent on business needs.
Essential Job Duties

• 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.
• Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards.
• Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
• Explains point-of-sale claims adjudication, state, NCQA 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, such as pill box requests, case management referrals, over the counter (OTC) requests, etc.
• Ability to multi-task applications while speaking with members.
• 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, including excellent phone etiquette.
• Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications (Not Required)

• Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.
• Health care industry experience.

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Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Same Posting Description for Internal and External Candidates

Pay Range: $14 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.