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Customer Service Representative, Medicare Pharmacy
Company | Molina Healthcare |
Address | United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-07-31 |
Posted at | 9 months ago |
- Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
- Assists member and providers with initiating oral and written coverage determinations and appeals.
- Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
- Assists with clerical services/tasks and other day-to-day operations as delegated.
- Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.
- Records calls accurately in call tracking system.
- Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.
- Maintains specific quality and quantity standards.
- National pharmacy technician certification
- 3-5 years; healthcare industry experience preferred
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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