Molina Healthcare · 3 days ago

Customer Service Representative, Medicare Pharmacy Department

Arizona, United States

Full-time

Remote

Entry Level

$20.29/hr - $28.82/hr

1+ years exp

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Responsibilities

Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.

Provides coordination and processing of pharmacy prior authorization requests and/or appeals.

Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.

Assists with clerical services/tasks and other day-to-day 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 member and providers with initiating oral and written coverage determinations and appeals.

Records calls accurately in call tracking system.

Maintains specific quality and quantity standards.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Customer Service ExperienceCall Center ExperienceHealthcare Industry ExperiencePharmacy Technician Certification