Pharmacy Technician

Advanced Medical Pricing Solutions•Phoenix, AZ

16d•Hybrid

About The Position

The Pharmacy Customer Service Advocate assists member, providers, and pharmacies with inquiries for member’s eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail, working independently within the scope of their duties. The Customer Service Advocate coordinates the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all maters to a proper resolution.

Requirements

Excellent verbal and written communication skills with high attention to detail
Excellent customer service skills
Strong analytical and problem-solving skills
Confident decision-making abilities
Demonstrated ability to work independently, prioritize workloads, multi-task effectively, and manage priorities to meet deadlines
High school diploma or equivalent required
PBM Experience
Minimum 2 years customer service or claims experience in the Health Insurance Industry
Must have experience in handling multi-line telecommunication systems and electronic documentation software
Knowledge of medical/pharmaceutical terminology required
Health Insurance/Eligibility and Benefit knowledge required

Nice To Haves

Preferred experience in Call Center Customer Service
Preferred experience in Pharmacy Tech
Prior authorization experience preferred
Bilingual a plus

Responsibilities

Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documents
Interpret plan documents/plan guidelines
Determine eligibility by reviewing, researching, and analyzing information in the appropriate system
Use critical thinking and reasoning to manage workload with above average level
Maintain and enter information into systems as information is received
Forward all records to the appropriate parties
Record and respond to calls/emails/faxes from Member, Providers, and Pharmacies
Maintain high level of knowledge to answer specific Pharmacy Plan Benefit information or sharing guideline related questions
Review issues as they arise
Serve as a role model in demonstrating core values of customer service
Provide timely and thorough responses to internal and external customers
Escalate difficult issues to the appropriate party
Provide exceptional customer service for incoming/outgoing calls
Propose process improvements to enhance customer service satisfaction
Ensure compliance with service standards
Develop and execute plans to meet established goals
Provide continuous feedback to strengthen and optimize quality performance
Work cross-departmentally to improve or streamline procedures
Maintain up to date knowledge on industry trends and look for new data sources
Develop or improve current internal processes to improve overall quality
Accurate and complete documentation of all daily interactions
Special projects as assigned