The Health Plan (THP) · 3 days ago
Member Advocate - Pharmacy
Wheeling, WV
Full-time
Onsite
Entry Level
1+ years expThe Health Plan (THP) is a healthcare organization seeking a Member Advocate for their Pharmacy Operations. The role involves coordinating copay assistance for members and guiding them in applying for low-income subsidy for Medicare Part D, while providing excellent customer service and ensuring timely documentation.
Health CareInsuranceNon ProfitWellness
Responsibilities
Complete timely and accurate documentation of contacts and outcomes in referral platform
Performs research to identify appropriate community resources and maintains information of available resources to meet various member needs
Directs members on how to apply for low-income subsidy for Medicare Part D
Prioritizes assignments appropriately and maintains flexibility as new priorities arise
Promotes communications, both internally and externally, to enhance effectiveness or pharmacy services for membership
Strives to improve quality in all areas of responsibility and cooperate with all departments to improve quality throughout The Health Plan
Ensures that all financial assistance applications are processed timely and accurately
Provide excellent customer service to members and providers
Consults with clinical pharmacists for guidance and assist if necessary
Gathers clinical documentation necessary for the performance of medication reconciliation and yearly medication reviews and refers documentation to a Care Management Pharmacist for review if needed
Work DSNP IR referrals for diabetic and nebulizer testing supplies
Work any pharmacy mail marked 'Return To Sender.'
Back-up for ACD lines and completes medication coverage requests during peak seasons and if short staffed
Meets internal key performance indicators as defined in The Health Plan’s Policies and Procedures
Member Advocates/Pharmacy Technicians are responsible for reporting any changes in licensure status (e.g., application declined/denied; license revoked/suspended or lapsed; notification of an investigation by licensing board; becoming subject to disciplinary action by a licensing board) to their direct supervisor throughout their term of employment
Qualification
Required
High School diploma or equivalent
National Pharmacy Technician Certification
One year experience in a retail, hospital, managed care, or other similar pharmacy setting
Minimum typing speed of 35 words per minute
Demonstrate working knowledge of direct claims processing, pharmacy computer systems, spreadsheet applications (i.e., Microsoft Excel), phone system and other office/computer equipment as required
Knowledge of pharmaceutical generic and trade names
Ability to comprehend and follow established office routines, policies, and procedures
Effective oral and written communication skills, including grammar and spelling
Strong organizational skills, time management and multi-tasking abilities
Detail oriented with advanced analytical and problem-solving skills
Ability to work effectively as part of a team and independently
Provide excellent customer service
Follow all plan policies and procedures
Preferred
Degree in health-related field
Experience performing medication authorizations in pharmacy or managed care environment
Company
The Health Plan (THP)
The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ryan J. Ralston
Chief Financial Officer
Bob Roset
Senior Vice President, Information Systems (CIO)
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