Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Pharmacy Customer Service Representative
Location
United States
Posted
6 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Pharmacy Customer Service Representative
Molina Healthcare
Role Description Molina Healthcare is hiring a Pharmacy Customer Service Representative. This role is remote for those who live in Florida only. Bilingual - Spanish speaking is needed. Our agents assist with all Medicaid member Pharmacy-related calls. You will assist the members with obtaining their medications. This is a pharmacy call center environment focused on first call resolution and the member's experience. Pharmacy Reps will be taking calls for the state of FL. Must be bilingual, and live in the state of FL. Shift times will be Monday through Friday 8:00a - 4:30p or 10:30a-7:00p EST, all dependent on business needs. Essential Job Duties - Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. - Contributes to overarching pharmacy strategy for optimization of 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. - 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 but not limited to: 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. Qualifications - 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. - 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. Requirements - 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. Benefits - Molina Healthcare offers competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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