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Priority Health · 1 day ago

Pharmacy Customer Service Representative

Grand Rapids, MI

Full-time

Onsite

Entry Level

2+ years exp

Priority Health is a health system committed to providing exceptional service and care to its members. The Pharmacy Customer Service Representative is responsible for handling inquiries related to pharmacy benefits, educating customers on drug formulary guidelines, and ensuring timely resolution of issues.

Health Care

Responsibilities

Demonstrates high competency in analyzing, evaluating, and responding to complex pharmacy benefit inquiries from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Professional and pleasant interactions are ongoing expectations

Utilizes clinical knowledge from pharmacy experience and/or education to be able to effectively discuss covered alternatives to find less expensive options on the formulary to treat diagnosis

Collaborating with internal and external resources, promptly provides customers with information and education concerning the drug formulary and prior authorization (coverage determination) requests and ensuring they are completed in a timely manner in accordance with NCQA & CMS requirements

Promptly recognizes customer concerns, grievances, and/or appeal rights resolving or escalating to the proper channels to achieve positive outcomes

Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements

Maintains CPhT certification through continuing education via CE Credits to ensure accuracy, consistency, and knowledge of current pharmacy practices/drug changes

If currently certified/licensed

Effectively documents all service interactions with customers within appropriate systems according to guidelines

Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule

Qualification

Pharmacy technician experienceCustomer service experienceCPhT certificationPharmacy billing/claim adjudicationCommunication skills

Required

High School Diploma or equivalent

1 year of relevant experience customer-facing service on phone or face to face; customer service, high volume call center, insurance environment relevant to benefits, and/or managed health care

2 years of relevant experience Pharmacy technician experience, pharmacy billing/claim adjudication