Pharmacy Benefits Specialist

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Respond to telephone inquiries in a courteous, professional, and efficient manner, ensuring outstanding customer service.

• Record all incoming calls and conversations in the claims adjudication software.

• Inform clients about plan policies, benefits, and procedures.

• Address client drug benefit issues related to medical, financial, or technological aspects.

• Initiate and manage prior authorization requests.

• Make outbound calls to pharmacies and plans to assist in the resolution of JIRA tickets.

• Review after-hours call logs and complete any necessary follow-up.

• Submit JIRA tickets for compound prescriptions.

• File JIRA tickets to resolve NDC-related issues, such as pricing discrepancies or missing NDCs.

• Stay updated on plan and benefit structures, pharmacological advancements, and Medicare Part D guidelines.

• Accept additional duties as assigned, including but not limited to direct member reimbursements, processing, manual claims, reporting, and investigating rejected claims.

• Ensure compliance with HIPAA guidelines in all communications with clients.

• Reflect AnewHealth’s Core Values in every interaction and communication.

⛳️ Requirements

• An associate’s degree or a comparable combination of education and work experience.

• CPhT (Certified Pharmacy Technician) Certification is preferred.

• At least 3 years of experience in customer service/member service within a call center or a similar setting.

• A minimum of 2 years of experience within the healthcare sector.

• At least 2 years of experience in a pharmacy support position.

• Familiarity with plan and benefit structures as well as Medicare guidelines.

• Knowledge of pharmacology and related terminology.

• Exceptional communication skills and professionalism when interacting with clients.

• Ability to make quick decisions and resolve problems under pressure while on calls.

• Detail-oriented with the ability to prioritize tasks effectively.

• Strong computer skills, including proficiency with word processors, spreadsheets, and database software.

🏝️ Benefits

• Medical, dental, and vision coverage starting on the 1st of the month following the date of hire.

• Flexible spending options.

• Company-sponsored life insurance.

• Short-term disability coverage.

• Optional voluntary benefits.

• 401(k) plan.

• Paid Time Off (PTO).

• Paid holidays.