Pharmacy Operations Representative – Medicaid

Role Overview

• Provide assistance to pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims
• Work closely with internal departments and external vendors to evaluate and resolve issues
• Support processes to ensure federal and state regulations and program requirements are met and maintained
• Communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits

Requirements

• Licensed and unrestricted Pharmacy Technician/Certified Pharmacy Technician (CPhT)
• Bachelor's degree in Business or a related health care field OR 4 years work experience in a pharmacy/health care/managed care industry
• Verbal and written communication skills
• Managed care customer service experience
• Proficiency of MS product suite; Word, Excel, Access, and database software
• Drug information skills
• Handle multiple tasks and strong organizational skills.
• Retail, Hospital, Specialty Pharmacy, Pharmacy Benefits Manager, Health Plan experience (preferred)
• Telephone support to include members inquiries, providers, pharmacies, and groups regarding benefits (preferred)
• Support through written and digital channels (preferred)
• Effectively working across / collaborating with internal stakeholders such as Customer Service Team, PBM/Pharmacy, Providers, members to resolve pharmacy related gaps in care, coverage & claims submission issues (preferred)
• Facilitate process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services (preferred)

Benefits

• Health insurance
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement