Pharmacy Benefits Specialist

Job Details

The Customer Support Specialist is responsible for answering calls from our clients and providing timely and accurate responses in a professional and courteous manner. This position works with internal and external clients which include members, clinicians, pharmacies, plan sponsors and other departments within the company.

Responsibilities

• Answer telephone inquiries in a pleasant, professional, and efficient manner assuring exceptional customer service.
• Document all incoming calls and dialogue in the claims adjudication software.
• Educate clients on plan policies, benefits, and procedures.
• Resolve client drug benefit concerns of a medical, financial, or technological nature.
• Initiate and facilitate prior authorization requests.
• Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets.
• Review after hours calls log-complete any follow up as needed.
• Submit JIRA tickets for compound prescriptions.
• Submit JIRA tickets to resolve NDC issues (pricing issues, missing NDCs).
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
• Accept other duties as assigned; including but not limited to direct member reimbursement, processing, manual claims, reporting, and researching rejected claims.
• Ensure that HIPAA guidelines are followed in every communication with clients.
• Embody AnewHealth’s Core Values in all communications and interactions.

Qualifications

• Education Required: Associate’s degree or equivalent combination of education or work experience.
• Preferred: CPhT (Certified Pharmacy Technician) Certification.
• Experience: A minimum of 3 years of experience in customer service/member service in a call center or similar.
• A minimum of 2 years of experience in the healthcare industry.
• A minimum of 2 years of experience in a pharmacy support role.
• Knowledge of plan and benefit structures and Medicare guidelines.

Skills & Abilities

• Knowledge of pharmacology and pharmacological terms.
• Excellent communication skills and professionalism when working with clients.
• Ability to solve problems under pressure by making immediate decisions while on the phone.
• Detail oriented and able to prioritize workload.
• Strong computer skills including using word processors, spreadsheets, and database software.

Physical/Mental Demands

This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within assigned territory. May be necessary to work extended hours as needed.

Schedule

This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Travel

Travel may be required for special organization or department events, department team meetings, trade shows, conferences, and other client engagements. This is a remote position.

Benefits

• AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays.
• Medical, dental and vision coverage are effective 1st of the month following date of hire.

Equal Employment Opportunity

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.