Pharmacy Customer Service Representative (Remote) Must Reside in NM

Molina Healthcare; Clayton (NM); Remote; USD 22.000 - 30.000; Vollzeit

Zusammenfassung

Molina Healthcare is hiring a Pharmacy Customer Service Representative. This role is remote for residents of New Mexico and will support inbound and outbound calls from members, providers, and pharmacies to optimize medication-related outcomes and cost-effective care.

The shift is Monday through Friday, 11am–7:30pm MST, with responsibilities across prior authorizations, formulary guidance, and case support.

Qualifikationen

• 1+ year of customer service or call center experience.
• Strong verbal and written communication skills.
• Ability to work independently on special projects.
• Proficient with Microsoft Office and basic software applications.

Aufgaben

• Handle inbound/outbound pharmacy calls from members, providers and pharmacies.
• Coordinate and process pharmacy prior authorization requests and/or appeals.
• Explain POS claims adjudication and CMS/NCQA policies to stakeholders.
• Record calls accurately in the call tracking system and maintain quality metrics.
• Assist with clerical tasks and day-to-day call center operations.
• Provide information on formulary, copays, location services, and coverage determinations.

Kenntnisse

Customer service

Call center

Multi-tasking

Verbal communication

Written communication

Independence

Tools

Microsoft Office

Excel

Jobbeschreibung

Molina Healthcare is Hiring a Pharmacy Customer Service Representative. This role is remote; however candidates must reside in New Mexico. This role will provide customer support for inbound and outbound pharmacy calls from members, providers, pharmacies, and helps optimize medication-related health care outcomes, and quality cost-effective member care. Shift will be Monday through Friday 11am to 730pm MST.

Essential Job Duties

• 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

• 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.
• Bilingual, Spanish candidate encouraged to apply.

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V