Medicare Pharmacy CSR (Remote PST Hours) - Molina Healthcare
Los Angeles, CA
About the Job
Molina Healthcare is Hiring For Medicare Pharmacy, Customer Service Reps!
These roles are remote within the US, however you will be working MST (Mountain Standard Time) business hours.
Preferred Availability is between the hours of 9am and 6pm, MST - Monday through Friday.
As a CSR in our Medicare Pharmacy Department, you will service Medicare members that have questions or experiencing issues related to pharmacy benefits. You will assist with inbound calls from members and providers regarding pharmacy benefit explanations such as copays and coverage phases, assisting with prior authorizations for non-covered medications, overrides, aiding pharmacy with billing information. You will also be making outbound calls to providers offices or pharmacy’s depending on the issue but majority of the time you are taking inbound calls.
Highly Qualified Candidates Will Have The Following:
+ Experience working in healthcare some capacity - Pharmacy or Health Insurance experience is a bonus!
+ Top notch communication skills, both written and verbal.
+ Customer service experience (in a Remote setting) is a plus!
+ Solid / Steady work history.
+ Ability to work Mountain Standard Hours of 9am to 6pm Monday through Friday.
Summary
Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies).
KNOWLEDGE/SKILLS/ABILITIES
+ 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.
JOB QUALIFICATIONS
Required Education: High School Diploma or GED equivalent
Preferred Education: Associate degree
Required Experience: 1-3 years of call center or customer service experience
Preferred Experience
+ 3-5 years; healthcare industry experience preferred
+ National pharmacy technician certification (Not Required)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $18 - $22 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
These roles are remote within the US, however you will be working MST (Mountain Standard Time) business hours.
Preferred Availability is between the hours of 9am and 6pm, MST - Monday through Friday.
As a CSR in our Medicare Pharmacy Department, you will service Medicare members that have questions or experiencing issues related to pharmacy benefits. You will assist with inbound calls from members and providers regarding pharmacy benefit explanations such as copays and coverage phases, assisting with prior authorizations for non-covered medications, overrides, aiding pharmacy with billing information. You will also be making outbound calls to providers offices or pharmacy’s depending on the issue but majority of the time you are taking inbound calls.
Highly Qualified Candidates Will Have The Following:
+ Experience working in healthcare some capacity - Pharmacy or Health Insurance experience is a bonus!
+ Top notch communication skills, both written and verbal.
+ Customer service experience (in a Remote setting) is a plus!
+ Solid / Steady work history.
+ Ability to work Mountain Standard Hours of 9am to 6pm Monday through Friday.
Summary
Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies).
KNOWLEDGE/SKILLS/ABILITIES
+ 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.
JOB QUALIFICATIONS
Required Education: High School Diploma or GED equivalent
Preferred Education: Associate degree
Required Experience: 1-3 years of call center or customer service experience
Preferred Experience
+ 3-5 years; healthcare industry experience preferred
+ National pharmacy technician certification (Not Required)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $18 - $22 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Source : Molina Healthcare
