Remote Pharmacy Support Specialist (NM Resident)

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. 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