Nebraska Staffing
divh2Pharmacy Call Center Representative/h2pProvides 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./ppShift Available: 12:30-9 PM MST/ppEssential Job Duties:/pulliHandles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards./liliProvides coordination and processing of pharmacy prior authorization requests and/or appeals./liliExplains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies./liliAssists with clerical tasks and other day-to-day pharmacy call center operations as delegated./liliEffectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes./liliAssists members and providers with initiating verbal and written coverage determinations and appeals./liliRecords calls accurately within the pharmacy call tracking system./liliMaintains established pharmacy call quality and quantity standards./liliInteracts with appropriate primary care providers to ensure member registry is current and accurate./liliSupports pharmacists with completion of comprehensive medication reviews (CMRs) through pre-work up to case preparation./liliProactively identifies ways to improve pharmacy call center member relations./lipRequired Qualifications:/pulliAt least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience./liliExcellent customer service skills./liliAbility to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc./liliAbility to multi-task applications while speaking with members./liliAbility to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors./liliAbility to meet established deadlines./liliAbility to function independently and manage multiple projects./liliExcellent verbal and written communication skills, including excellent phone etiquette./liliMicrosoft Office suite (including Excel), and applicable software program(s) proficiency./li/ulpPreferred Qualifications:/pulliCertified 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./liliHealth care industry experience./li/ulpMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level./p/ul/div