Pharmacy Support Representative

Qualifications:

  • Associates Degree in Health Care, Pharmacy, or a related field with a minimum of 2 years’ experience in a pharmacy, PBM, or health insurance environment or an equivalent combination of education and experience
  • Above average computer and MS Office proficiency and ability to navigate a variety of systems/portals
  • Strong verbal/written communication skills and customer service experience
  • Excellent task initiative and demonstrated problem solving and critical thinking skills
  • Multi-tasking, priority setting, and detail oriented skills applied in a fast paced environment

Preferred qualifications:

  • Pharmacy Technician Certification or equivalent
  • Experience with pharmacy or medical terminology

General Responsibilities and Job Duties:  

  • Act as a primary resource and contact for members, providers, pharmacies, and internal areas relating to pharmacy requests and provide follow-up as to decisions made regarding requests for these services.
  • Answer incoming phone calls routed to dedicated pharmacy line and research and resolve complex inquiries using the appropriate pharmacy resources and portals.
  • Coordinate with pharmacy/clinical team, enrollment, customer service, account management, PBMs, and pharmacies for appropriate problem resolution related to eligibility, prescription benefits and cost-sharing, overrides, denials, authorizations, and member reimbursement.
  • Intake and triage prescription prior authorization requests for review by clinical staff.
  • Submit pharmacy overrides via PBM portal and/or service contact.
  • Produce routine reporting on pharmacy utilization, coordinate with PBMs on additional reporting requests, and review reports for quality prior to delivering to end users or filing
  • Support the PBM implementation of plan benefits and clinical design  for new groups or to reflect changes associated with existing groups or renewals
  • Assist in auditing of the prescription benefit design and PBM configuration of the design.
  • Adhere to all company, regulatory, and accreditation standards, policies and procedures relating to member confidentiality documentation, quality and turnaround times.
  • Provide assistance to the Pharmacy/Clinical Programs Manager on ad hoc projects that support pharmacy needs and benefit the company as a whole.
  • Other duties as assigned.

Reporting to: Pharmacy and Clinical Program Manager

Please send your resume and completed application to CHP Human Resources at:

Mail: Consolidated Health Plans, Human Resources, 2077 Roosevelt Avenue, Springfield, MA 01104-3503

Fax: (413) 452-5329 Attn. Human Resources

Email: human_resources@consolidatedhealthplan.com

Phone: (413) 733-4540 ext. 120

 

Employment Application

Download Employment Application

 

For more information contact us at human_resources@consolidatedhealthplan.com or call us at (413) 733-4540 ext. 120