Pharmacy Representative

Pharmacy Representative page is loaded## Pharmacy Representative locations:
Hinghamtime type:
Full time posted on:
Posted 2 Days Agojob requisition :
R08275##
** The Role
** The Pharmacy Operations Analyst is responsible for primary contact for our providers to obtain authorization for Medicare retail pharmacy, home infusion and medical utilization management requests. These requests are received via fax, phone and web. In addition, the Pharmacy Operations Analyst supports inquiries from other business areas via phone and email.
*
* Key Responsibilities:

*** Receive, process, and archive provider’s retail fax and phone authorization requests accurately using multiple computer systems against our Medical Policy Criteria.
* Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email.
* Analyze and interpret high level medical data and accurately data entry information according to NCQA guidelines.
* Receive, process, and archive Home Infusion Therapy and Utilization Management Medical requests accurately using MHK and other systems via fax or telephone.
* Communicate determinations to providers via incoming and outgoing telephone calls.
* Process pharmacy authorizations utilizing PBM real time on line claims adjudication software.
* Support new clinical program implementation.
* Serve as a liaison to Member Services and other internal clients for real-time support on pharmacy benefit interpretation, Medical Policy interpretation, and plan design interpretation.
* Support Medicare Part D and understanding of CMS guidelines
* Other responsibilities as needed.
This position has been identified as essential to the operations of the company in the event of a building closure due to weather, emergency, or disaster. Holding an essential position, you may be expected to bring a company issued laptop home and work from home or other remote location in the event of a building closure, emergency, or disaster.
*
* Qualification:

*** Excellent Customer Service skills.
* Prior experience assisting members and/or providers with telephone inquiries.
* Strong organizational, problem solving, communication, and interpersonal skills.
* Excellent written and oral communication skills required.
* Must have strong data entry and attention to detail in building cases.
* Must be able to multitask and be results oriented.
** Education/Relevant

Experience:

*** Minimum of a High School diploma required. Associate or Bachelor’s degree preferred.
* Proficiency in MHK and CVS PBM Systems.
* Experience in a Windows environment preferred.
* Previous experience in a managed care environment preferred.
* Previous pharmacy experience preferred.## Minimum

Education Requirements:

High school degree or equivalent required unless otherwise noted above## Location Hingham## Time Type Full time Hourly Range: $21.86 - $27.42  The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  

An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:

No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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