Pharmacy Customer Service Representative
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Job Location:
Grand Rapids, MI - USA
Monthly Salary:
Not Disclosed
Posted on:
12 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Summary
While maintaining the integrity of the sensitive information of our membership a Pharmacy Customer Service Representative is to provide efficient and accurate responses to external customers (physicians/office staff pharmacy providers members and agents) and internal team members regarding health plan benefits including accessing services resolving complex problems pharmacy claim rejections and overrides group/member eligibility problems and other non-routine questions. Educates customers on drug formulary guidelines including drug formulary alternatives and prior authorization criteria. Consistently create an exceptional experience with each contact via inbound and outbound calls face-to-face interactions online chat fax email etc.
Essential Functions
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/licensedEffectively 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.
Qualifications
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
Preferred
Associates Degree
CRT-Pharmacy Technician Certified (CPHT) - PTCB Pharmacy Technician Certification Board Upon Hire
LIC-Pharmacy Technician - STATEMI State of Michigan Upon Hire
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1231 E Beltline - Grand RapidsDepartment Name
PH - Pharmacy Contact CenterEmployment Type
Full timeShift
Variable (United States of America)Weekly Scheduled Hours
40Hours of Work
Variable 8 a.m. to 8 p.m.Days Worked
Monday to FridayWeekend Frequency
Variable weekendsCURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
Unclear Seniority
Key Skills
- Typing
- Data Entry
- Customer Service
- Basic Math
- Computer Skills
- Windows
- Banking
- Upselling
- Pricing
- Sanitation
- Cash Handling
- Stocking
About Company
Corewell Health is committed to granting equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status
