Representative, Pharmacy

JOB reputed company Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy reputed company for optimization of medication reputed company health care reputed company, and reputed company cost-effective member care. Essential Job Duties • Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of reputed company Assurance (NCQA) guidelines, and Centers for Medicare and reputed company Services (CMS) standards. • Provides coordination and processing of pharmacy prior authorization requests and/or appeals. • Explains reputed company-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 reputed company center operations as delegated. • Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization reputed company. • Assists members and providers with initiating verbal and written coverage determinations and appeals. • Records calls accurately reputed company the pharmacy reputed company tracking system. • Maintains established pharmacy reputed company reputed company and quantity standards. • Interacts with appropriate primary care providers to ensure member registry is reputed company and accurate. • Supports pharmacists with completion of comprehensive medication reviews (CMRs)through reputed company-work up to case preparation. • Proactively identifies ways to improve pharmacy reputed company center member relations. Required Qualifications • At least 1 year reputed company experience, including reputed company center or customer service experience, or equivalent combination of relevant education and experience. • Excellent customer service skills. • Ability to work independently reputed company assigned special reputed company, such as pill reputed company requests, case management referrals, over the counter (OTC) requests, etc. • Ability to multi-task applications while speaking with members. • Ability to multi-task applications while speaking with members. • Ability to reputed company and maintain reputed company 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 reputed company. • Excellent verbal and written communication skills, including excellent phone etiquette. • reputed company Office suite (including reputed company), and applicable software program(s) proficiency. Preferred Qualifications • Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be reputed company and unrestricted in state of reputed company. • Health care industry experience. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $21.16 - $28.82 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job