Remote Pharmacy CSR: Prior Auth & Benefits

Molina Healthcare; United States; Remote; USD 15,000 - 33,000; Full time

Benefits offered by this job

Competitive benefits

Equal Opportunity Employer (EOE)

Job summary

Molina Healthcare is hiring for a fully remote Customer Service (Phone) Pharmacy Representative. You will handle inbound and outbound pharmacy calls from members, providers, and pharmacies, providing information on copays, benefits, prior auths, and other pharmacy program details.

Hours are Monday to Friday 12:30 PM to 9:00 PM MST. The role supports pharmacy call center operations, records calls in the tracking system, assists with prior authorizations, appeals, and coverage determinations, and

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.
• Proficiency with Microsoft Office and Excel.

Responsibilities

• Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies.
• Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
• Explains point-of-sale claims adjudication, CMS and NCQA policies to providers, members and pharmacies.
• Assists with clerical tasks and other day-to-day pharmacy call center operations.
• Communicates plan benefits including formulary information and copay amounts.
• Assists 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 primary care providers to ensure member registry is current.
• Supports pharmacists with comprehensive medication reviews (CMRs) from pre-work to case prep.
• Proactively identifies ways to improve pharmacy call center member relations.

Skills

Customer service

Phone etiquette

Multi-tasking

Written and verbal communication

Microsoft Office

Job description

Molina Healthcare is hiring for a fully remote Customer Service (Phone) Pharmacy Representative. You will handle inbound and outbound pharmacy calls from members, providers, and pharmacies, providing information on copays, benefits, prior auths, and other pharmacy program details.

Hours are Monday to Friday 12:30 PM to 9:00 PM MST. The role supports pharmacy call center operations, records calls in the tracking system, assists with prior authorizations, appeals, and coverage determinations, and