Pharmacy Benefits Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Respond to telephone inquiries in a friendly, professional, and efficient manner

• Deliver timely and precise answers to clients, including members, clinicians, pharmacies, plan sponsors, and internal departments

• Record incoming calls and conversations in claims adjudication software

• Educate clients about plan policies, benefits, and procedures

• Address medical, financial, or technological drug benefit issues

• Initiate and manage prior authorization requests

• Make outbound calls to pharmacies and plans to ensure JIRA ticket completion

• Review after-hours call logs and conduct follow-up as necessary

• Submit JIRA tickets for compound prescriptions

• File JIRA tickets to resolve NDC-related issues, including pricing discrepancies and missing NDCs

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

• Conduct direct member reimbursements, processing, manual claims, reporting, and research on rejected claims as assigned

• Ensure adherence to HIPAA guidelines in all client communications

• Reflect AnewHealth’s Core Values in all communications and interactions

• Travel to special organizational or departmental events, team meetings, trade shows, conferences, and other client engagements as required

⛳️ Requirements

• Associate’s degree or a comparable combination of education and work experience

• CPhT (Certified Pharmacy Technician) Certification preferred

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

• Minimum of 2 years of experience in the healthcare sector

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

• Understanding of plan and benefit structures as well as Medicare guidelines

• Familiarity with pharmacology and pharmacological terminology

• Exceptional communication skills and professionalism when interacting with clients

• Capability to solve problems under pressure by making immediate decisions while on calls

• Detail-oriented and capable of prioritizing workload effectively

• Proficient computer skills including experience with word processors, spreadsheets, and database software

• Availability outside of regular business hours on an ad-hoc basis

• Ability to work scheduled hours from 11:30 AM to 8:00 PM Eastern Standard Time

• Applicants must have eligibility to work in this country

🏝️ Benefits

• Medical, dental, and vision insurance

• Flexible spending account

• Company-sponsored life insurance

• Short-term disability coverage

• Optional benefits

• 401(k) plan

• Paid Time Off

• Paid holidays

• Option for remote work arrangement