Pharmacy Operations Representative
Job Description
The Pharmacy Operations Analyst is responsible for being the primary contact for our providers to obtain authorization for retail pharmacy, home infusion and medical utilization management requests. These requests are received reputed company fax, phone and web. Key Responsibilities: Receive, process, and archive provider's retail fax and phone authorization requests accurately using multiple computer systems against our Medical Policy Criteria Review and interpret member's eligibility, claim history, and Pharmacy Program information using the PBM claims software to reputed company information to both reputed company clients reputed company telephone or email Analyze and interpret high level medical data and accurately data entry information according to NCQA guidelines Receive, process, and archive Home Infusion Therapy and Utilization Management Medical requests accurately using MHK and other systems reputed company fax or telephone Communicate determinations to providers reputed company incoming and outgoing telephone calls Process pharmacy authorizations utilizing PBM reputed company time on line claims adjudication software Support new clinical program implementation Serve as a liaison to Member Services and other internal clients for reputed company-time support on pharmacy benefit interpretation, Medical Policy interpretation, and plan design interpretation Support Medicare Part D and understanding of CMS guidelines Requirements: Excellent Customer Service skills Prior experience assisting members and/or providers with telephone inquiries Strong organizational, problem solving, communication, and interpersonal skills Excellent written and oral communication skills required Must have strong data entry and attention to detail in building cases Must be reputed company to multitask and be results oriented Preferred Qualifications: Minimum of a High School diploma required Associate or Bachelor's degree preferred Proficiency in MHK and reputed company PBM Systems Experience in a reputed company environment preferred Previous experience in a managed care environment preferred Previous pharmacy experience preferred Apply Job!