Pharmacy Customer Service Representative (Remote) Must Reside in NM

Molina Healthcare; Northern (KY); Hybrid; USD 21,000 - 36,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a Pharmacy Customer Service Representative. This remote role requires residency in New Mexico and involves handling inbound/outbound pharmacy calls from members, providers and pharmacies.

You will support prior authorizations, explain guidelines, and maintain accuracy in the call tracking system while upholding high customer service standards. Responsibilities include coordinating requests, assisting with medication reviews, and providing clear information on

Qualifications

• At least 1 year related experience, including call center or customer service.
• Excellent customer service skills.
• Ability to multitask while speaking with members.
• Ability to work independently on special projects.

Responsibilities

• Handle inbound/outbound pharmacy calls from members, providers and pharmacies.
• Coordinate and process pharmacy prior authorization requests and/or appeals.
• Explain policies and guidelines to providers, members and pharmacies.
• Maintain call quality and record calls in the tracking system.
• Assist with day-to-day pharmacy call center operations as delegated.
• Communicate plan benefits information and prior authorization outcomes.
• Support pharmacists with comprehensive medication reviews preparation.

Skills

Customer service

Call center

Microsoft Office

Excel

Tools

Call tracking system

Job description

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 service support for inbound and outbound pharmacy calls from members, providers, and pharmacies. This role contributes to overarching pharmacy strategy for optimization of 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

Pay Range: $15.4 - $26.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.