Molina Healthcare is hiring for several Pharmacy Customer Service Representatives. These positions are remote, however those in later time zones are encouraged to apply.
This team handles the Pharmacy UM / Prior Authorization calls and services external calls from providers with Medicaid and/or Marketplace members. Our agents assist with all Medicaid and Marketplace member Pharmacy-related calls. This is a pharmacy call center environment focused on first call resolution and the member's experience.
Shift times will be Monday through Friday 1PM to 930PM EST and 10AM to 630PM PST all dependent on business needs.
Essential Job Duties
- Provides 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.
- Handles 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.
- Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
- Explains point-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 call center operations as delegated.
- Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
- Assists members and providers with initiating verbal and written coverage determinations and appeals.
- Records calls accurately within the pharmacy call tracking system.
- Maintains established pharmacy call quality and quantity standards.
- Interacts with appropriate primary care providers to ensure member registry is current and accurate.
- Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation.
- Proactively identifies ways to improve pharmacy call center member relations.
Required Qualifications
- At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
- Excellent customer service skills.
- Ability to work independently when assigned special projects, such as pill box 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 develop and maintain positive 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 projects.
- Excellent verbal and written communication skills, including excellent phone etiquette.
- Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
Preferred Qualifications (Not Required)
- Certified 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.
- Health care industry experience.
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To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Same Posting Description for Internal and External Candidates
Originally posted on Himalayas