Pharmacy Support Representative
- 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
- 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
Phone: (413) 733-4540 ext. 120
For more information contact us at firstname.lastname@example.org or call us at (413) 733-4540 ext. 120