Pharmacy Benefits Specialist

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.
• →Ensures that HIPAA guidelines are followed in every communication with clients.
• →Embody AnewHealth’s Core Values in all communications and interactions.
• →Other duties as assigned.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job.  Not all of the duties may be assigned to a position.

• 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.