Pharmacy Customer Service Representative (Remote) Must Reside in NM

Molina Healthcare; Santa Fe (NM); Remote; USD 31,000 - 42,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is hiring a Pharmacy Customer Service Representative. This role is remote; however candidates must reside in New Mexico. You will provide customer service support for inbound and outbound pharmacy calls from members, providers, and pharmacies, contributing to optimized medication health care outcomes.

Shift is Monday through Friday 11am to 7:30pm MST. The team handles prior authorizations, coverage determinations, and requires strong communication and multitasking skills, with

Qualifications

• 1 year related experience in call center or customer service.
• Excellent customer service skills.
• Ability to work independently on special projects.
• Ability to multitask while speaking with members.
• Ability to maintain positive work relationships with coworkers, members, providers, and regulators.
• Ability to meet deadlines.
• Ability to function independently and manage multiple projects.
• Excellent verbal and written communication skills including phone etiquette.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Handle inbound/outbound pharmacy calls from members, providers, and pharmacies per policies and CMS/NCQA guidelines.
• Coordinate and process prior authorization requests and/or appeals.
• Explain POS claims adjudication and policy guidelines to providers, members, and pharmacies.
• Assist with clerical tasks and day-to-day call center operations as needed.
• Communicate plan benefits, formulary information, copays, and prior authorization outcomes.
• Assist members/providers with verbal/written coverage determinations and appeals.
• Record calls accurately in the call tracking system.
• Maintain call quality and quantity standards.
• Interact with primary care providers to ensure up-to-date member registry.
• Support pharmacists with CMRs through pre-work and case prep.
• Identify ways to improve call center member relations.

Skills

Customer service

Verbal and written communication

Phone etiquette

Multitasking

Independent work

Relationship building

Deadline oriented

Tools

Microsoft Office

Excel

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