Remote Pharmacy Support Specialist – New Mexico

Molina Talent Acquisition; New Mexico; Teletrabalho; USD 21 000 - 36 000; Tempo integral

Resumo da oferta

Molina Healthcare is seeking a Pharmacy Customer Service Representative to support members, providers, and pharmacies from a remote NM location. You will handle inbound/outbound calls, explain benefits and formulary details, and assist with prior authorizations and coverage determinations.

The role requires strong customer service skills, the ability to multitask, and independent work habits, with a Monday–Friday shift 11am–7:30pm MT.

Qualificações

• 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.

Responsabilidades

• Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, NCQA guidelines, and 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 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.

Conhecimentos

Customer service

Multitasking

Communication

Independent work

Spanish (Bilingual)

Ferramentas

Microsoft Office

Excel

Descrição da oferta de emprego

Molina Healthcare is seeking a Pharmacy Customer Service Representative to support members, providers, and pharmacies from a remote NM location. You will handle inbound/outbound calls, explain benefits and formulary details, and assist with prior authorizations and coverage determinations.

The role requires strong customer service skills, the ability to multitask, and independent work habits, with a Monday–Friday shift 11am–7:30pm MT.