PHARMACY SERVICE SPECIALIST - ONE YEAR CONTRACT
To provide information, education, and assistance to pharmacies, members, and a variety of other callers on recorded phone lines regarding benefits, claims, and eligibility. The manner in which our customers are treated during each interaction is critical to retaining them and to the overall success of the corporation.
The Pharmacy Services Specialist III is responsible for a variety of projects and assignments. They will be involved with the more complex and in depth issues that need to be researched and responded to.
Minimum Job Qualifications and Technical Competencies
- Ability to perform all essential job duties and responsibilities of a Pharmacy Services Specialist I and II at the core level for 6 consecutive months.
- Ability to support and/or lead the efforts on various projects and assignments.
- The Specialist III may be required to perform any function of a Specialist II.
- Assist in identifying and implementing solutions for process gaps, trends and other opportunities to improve overall service.
- Must set a positive example for all members of the team by consistently demonstrating integrity, dependability and teamwork.
- May be required to assist, support, and lead projects / assignments such as the ones listed below:
- Pharmacy recovery – Involves regular research and review of requests for recovery, negotiation of payment plans with customers, handling of escalated phone calls, review of requests from membership or finance and reporting of recovery efforts for management.Correspondence – Involves responding to incoming correspondence both written and electronic in a timely, professional and accurate manner.Check Requests – Involves reviewing requests needing to have a check traced, stopped or reissued. Coordinates all processes with finance to ensure accurate payment to members and providers.
- Staff Training – Involves assisting with classroom training, coaching and mentoring of new and existing phone staff. This also includes maintaining and presenting the Rx101 training program which focus on certain medications and their primary use; prior authorization and quantity level limits; and a high level overview on how retail and mail order pharmacies work. The Specialist III will work to ensure this training program is kept current and will coordinate any changes / updates with our clinical team to ensure the training tool is accurate.
- Call Center Support – Involves taking phone calls on a as needed or on a regular basis, acting as a resource for other phone specialists and handling escalated or “supervisor “ calls as directed by a supervisor. Reviewing Project Coordinator templates to ensure accuracy and necessity and communicating results of the template to the appropriate people may be required.
- Configuration Support – Involves manually loading and correcting of eligibility on the Rx claims processing system, reviewing and issuing of accumulator credits and reviewing of claims history when benefits have been set up incorrectly.
- Clinical/Contracting Support – Involves providing member education on new Rx benefits / coverage’s or to load authorizations into the claims processing system for the grandfathering of prior authorization medications.
OTHER JOB DUTIES AND RESPONSIBILITIES
- Participate in team building activities, task forces or work groups, or other training and/or process improvement teams as needed.
- Complete special assignments as requested by management.
- Perform functions of quality assurance, monitoring, auditing, reporting, and trend analysis, as directed.
- May provide face to face customer service in the lobby or walk-in area.
- Work overtime as needed.
- Performs on-line benefit exceptions for members.
Job Requirements & Worksite Info
14.00 - 16.00
Are you interested in this position? Please complete our On-Line Application. Please note that your application will remain on file for 90 days for consideration for any of our open positions that match your qualifications.
If you have completed our on-line application in the last 90 days you can send a letter of interest to the recruiter hiring for this position at firstname.lastname@example.org. Please include a copy of your resume with your email or application.