Remote Pharmacy Customer Service & Prior Authorization

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 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.