Pharmacy Benefits Specialist

Customer Support Specialist AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. With over 1,400 team members, we care for more than 100,000 people across all 50 states. Responsibilities Answer telephone inquiries in a pleasant, professional, and efficient manner assuring exceptional customer service. Document all incoming calls and dialogue in the claims adjudication software. Educate clients on plan policies, benefits, and procedures. Resolve client drug benefit concerns of a medical, financial, or technological nature. Initiate and facilitate prior authorization requests. Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets. Review after hours calls log-complete any follow up as needed. Submit JIRA tickets for compound prescriptions. Submit JIRA tickets to resolve NDC issues (pricing issues, missing NDCs) Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines. Accept other duties as assigned; including but not limited to direct member reimbursement, processing, manual claims, reporting, and researching rejected claims. Ensures that HIPAA guidelines are followed in every communication with clients. Embody AnewHealth's Core Values in all communications and interactions. Other duties as assigned. Qualifications Education Required: Associate's degree or equivalent combination of education or work experience. Preferred: CPhT (Certified Pharmacy Technician) Certification. Experience A minimum of 3 years of experience in customer service/member service in a call center or similar. A minimum of 2 years of experience in the healthcare industry. A minimum of 2 years of experience in a pharmacy support role. Knowledge of plan and benefit structures and Medicare guidelines. Skills & Abilities Knowledge of pharmacology and pharmacological terms. Excellent communication skills and professionalism when working with clients. Ability to solve problems under pressure by making immediate decisions while on the phone. Detail oriented and able to prioritize workload. Strong computer skills including using word processors, spreadsheets, and database software. Schedule This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel Travel may be required for special organization or department events, department team meetings, trade shows, conferences, and other client engagements. This is a remote position. Benefits AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire. AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country. ExactCare Pharmacy