Representative, Pharmacy - Remote Inbound calls

• About Our Client: The organization operates within the healthcare sector, focusing on pharmacy services that support medication-related health outcomes. It addresses the challenge of coordinating cost-effective, quality pharmacy care for members by managing pharmacy calls and prior authorization processes in compliance with state regulations and national quality standards. The organization adheres to guidelines from the National Committee of Quality Assurance and Centers for Medicare and Medicaid Services, emphasizing regulated and quality-driven healthcare services.

• About the Opportunity:

The Representative, Pharmacy - Remote Inbound calls role provides essential customer service support by handling inbound and outbound pharmacy calls from members, providers, and pharmacies. This position contributes to optimizing medication health outcomes and cost-effective care by managing prior authorizations, appeals, and explaining pharmacy policies. The role supports pharmacy call center operations, facilitates communication regarding plan benefits, and assists pharmacists in comprehensive medication reviews, directly impacting the quality of member care.

• Responsibilities:
• Handle and record inbound/outbound pharmacy calls in compliance with policies, regulations, and quality standards
• Coordinate and process pharmacy prior authorization requests and appeals
• Explain claims adjudication and policy guidelines to members, providers, and pharmacies
• Perform clerical tasks and support daily pharmacy call center operations
• Communicate plan benefit information including formulary, copays, and pharmacy services
• Assist with verbal and written coverage determinations and appeals
• Accurately record calls in the pharmacy call tracking system
• Maintain pharmacy call quality and quantity standards
• Interact with primary care providers to keep member registries current
• Support pharmacists with comprehensive medication review preparation
• Identify opportunities to improve member relations in the pharmacy call center
• Requirements:
• Minimum 1 year of related experience, including call center or customer service experience, or equivalent education and experience
• Strong customer service skills
• Ability to work independently on special projects such as pill box requests and case management referrals
• Ability to multitask applications while communicating with members
• Ability to maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors
• Ability to meet deadlines and manage multiple projects independently
• Excellent verbal and written communication skills, including phone etiquette
• Proficiency with Microsoft Office suite (including Excel) and other relevant software programs

Preferred Qualifications

• Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license if required, with active and unrestricted status
• Experience in the healthcare industry
• Pay Range and Compensation Package:
• The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS. Apply tot his job Apply To this Job