Pharmacy CSR, Remote

About the role

Molina Healthcare is hiring Pharmacy Customer Service Representatives for remote positions. Those in later time zones are encouraged to apply. The team handles Pharmacy UM/Prior Authorization calls and services external calls from providers with Medicaid and/or Marketplace members. Agents assist with all Pharmacy-related calls and provide support for optimizing medication-related health care outcomes.

Responsibilities

• Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies.
• Contributes to the pharmacy strategy for optimizing medication-related health care outcomes and quality cost-effective member care.
• Handles and records inbound/outbound pharmacy calls from members, providers, and pharmacies in accordance with departmental policies, state regulations, NCQA guidelines, and CMS standards.
• Coordinates and processes 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.
• Affords assistance 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.
• Affords assistance 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.
• Affords assistance with ensuring the member registry is current and accurate.
• Affords assistance with completing comprehensive medication reviews (CMRs) through pre-work up to case preparation.
• Proactively identifies ways to improve pharmacy call center member relations.

Requirements

• 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, OTC requests, etc.
• Ability to multi-task while speaking with members.
• Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
• Ability to meet established deadlines.
• Ability to function independently and manage multiple projects.
• Excellent verbal and written communication skills, including excellent phone etiquette.
• Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications

• Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required).
• If licensed, license must be active and unrestricted in state of practice.
• Health care industry experience.