Ametros ยท 12 hours ago
Senior Associate, RX Specialist
MA Wilmington
Full-time
Onsite
Mid, Senior Level
3+ years expAmetros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. The Rx Specialist is primarily responsible for providing customer service on all pharmacy related services, including assisting members with pharmacy inquiries and resolving pharmacy rejected claims.
Insurance
Responsibilities
Responsible for answering inbound calls and assisting members with pharmacy related services
Contacting members to obtain any required pharmacy related information
Monitor and resolve all pharmacy rejected claims within the established turnaround times and in compliance with Medicare and regulatory requirements
Follow-up on authorization requests in a timely fashion
Contact members to obtain necessary approval on rejected pharmacy claims
Contact PBM as needed to resolve any complex pharmacy issues
Document all communication, upload appropriate documents to internal database, and document clear concise notes in our database to ensure accounts are up to date
Proactively identify issues, and work toward resolution
Act in compliance with security and HIPAA policies and procedures
Qualification
Required
Weekend availability required for occasional (1-2 per month) Saturday/Sunday coverage rotation
Proficient with prescription terminology and authorization practices
Knowledge of healthcare information systems, Rx products and pharmacy services
Previous experience in pharmacy retail, medical, or customer service setting
Previous experience as a Pharmacy technician
Telephone etiquette
Excellent customer service skills
Strong analytical and problem-solving skills
Thorough understanding and proficient use of customer service best practices and techniques in the Pharmacy Benefit industry
Working knowledge of healthcare information systems and knowledge of Rx products and pharmacy services
Strong conflict management and customer service skills
Strong interpersonal and communication skills
Client management and relationship building
Ability to foster a positive and productive work environment
Ability to work in a dynamic fast paced atmosphere
H.S. Diploma or General Education Degree (GED) required
3-4 years experience in a pharmacy setting, ideally a call center pharmacy setting required
Experience with prescription terminology and authorization practices required
Experience with computer systems required, including some Microsoft application which may include Outlook, Work, Excel, PowerPoint or Access required
Preferred
National Certification from an accredited pharmacy technician certification program preferred
Company
Ametros
Ametros, the industry leader in professional administration, transforms how injured individuals manage their healthcare after a settlement.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Porter Leslie
CEO
Michael C.
Co-Founder & Chief Corporate Development Officer
Recent News
2023-12-16
Business Wire
2023-09-06
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