[Hiring] Pharmacy Benefits Specialist @AnewHealth

Role Description

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.

• 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.
• Other duties as assigned.

Qualifications

• Required: Associate’s degree or equivalent combination of education or work experience.
• Preferred: CPhT (Certified Pharmacy Technician) Certification.
• 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.
• 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.

Requirements

• This is a full-time position with an expectation to work an average of 40 hours per week.
• Be available outside of normal business hours to meet customer expectations on an ad-hoc basis.
• Scheduled hours 11:30am to 8:00pm Eastern Standard Time.
• 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

• 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.