Molina Healthcare is hiring for several Pharmacy Customer Service Representatives.
These positions are remote, however those in later time zones are encouraged to apply.
This team handles the Pharmacy UM / Prior Authorization calls and services external calls from providers with Medicaid and/or Marketplace members.
Our agents assist with all Medicaid and Marketplace member Pharmacy-related calls.
This is a pharmacy call center environment focused on first call resolution and the member's experience.
Shift times will be Monday through Friday 1PM to 930PM EST and 10AM to 630PM PST all dependent on business needs.
Essential Job Duties Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies.
Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards.
Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated.
Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
Assists members and providers with initiating verbal and written coverage determinations and appeals.
Records calls accurately within the pharmacy call tracking system.
Interacts with appropriate primary care providers to ensure.