Pharmacy Operations Representative - Medicaid

Health Care Service Corporation•Albuquerque, NM

2d•$38,100 - $80,000•Hybrid

About The Position

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. HCSC is looking for an individual to join its Medicaid Pharmacy Operations team! This position is responsible for providing assistance to the customer service team, pharmacy coordinators, pharmacists, coworkers and members in resolution of various pharmacy claims, and issues. Will also work closely with internal departments and external vendors to evaluate and resolve issues; supports processes to ensure federal and state regulations and program requirements are met and maintained; and communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits. This role requires working in the Albuquerque office at least 3 days a week and working from home up to 2 days a week. Core business hours are 8:00 AM – 5 PM MST Monday through Friday.

Requirements

Certified Pharmacy Technician – current CPhT.
Bachelor's degree in Business or a related health care field OR 4 years work experience in a pharmacy/health care/managed care industry.
Verbal and written communication skills.
Managed care customer service experience.
Proficiency of MS product suite; Word, Excel, Access, and database software.
Drug information skills.
Handle multiple tasks and strong organizational skills.
Current Licensed/Certified Pharmacy Technician.
Experience in fast paced production environment with attention to detail is needed.

Nice To Haves

Retail, Hospital, Specialty Pharmacy, Pharmacy Benefits Manager, Health Plan experience.
Telephone support to include members inquiries, providers, pharmacies, and groups regarding benefits.
Support through written and digital channels.

Responsibilities

Providing assistance to the customer service team, pharmacy coordinators, pharmacists, coworkers and members in resolution of various pharmacy claims, and issues.
Working closely with internal departments and external vendors to evaluate and resolve issues.
Supporting processes to ensure federal and state regulations and program requirements are met and maintained.
Communicating pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits.
Effectively working across / collaborating with internal stakeholders such as Customer Service Team, PBM/Pharmacy, Providers, members to resolve pharmacy related gaps in care, coverage & claims submission issues.
Facilitating process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services.