Representative, Pharmacy - Remote Inbound calls

Job description

Mon - Fri Hours: depends of shits/zone: - 9:00am PST - 5:30pm PST - 10:00am MST - 6:30pm MST - 11:00am CST - 7:30PM CST - 12:00pm EST - 8:30pm EST Or: JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. - 9:30am PST - 8pm PST - 10:30am MST - 9pm MST - 11:30am CST - 10pm CST - 12:30pm EST - 11pm EST Essential Job Duties: - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively c...