Job Description:

Schedule

Mon-Fri 8-5, no weekends or holidays

Job Essentials
Receives incoming calls from members, providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values, and quality standards.
Maintains the confidentiality of member personal information to be compliant with internal confidentiality policy.
Maintains customer history in member tracking using correct codes and detailed comments.
Utilizes several applications and tools to respond to inquiries regarding pre- and post-enrollment, benefits, cost sharing, Medicare forms, True Out Of Pocket (TrOOP) status, and the formulary transition process.
Assists Medicare members with the Part D grievance, coverage determination (including exceptions), and appeals process.
Required to meet all department standards pertaining to call statistics, production, documentation, and quality and accuracy.
Certified on phones previously.
Certified on PAs previously.
Pursues excellence by continually looking for ways to improve processes and systems. Acts as a resource to Pharmacy Benefits Claims staff and assists in training and documentation at the supervisor's request.
Acts as a mentor. Willingly coaches and develops others and provides effective feedback.
Represents and participates in Medicare meetings or projects as assigned by supervisor.
Aides in the dissemination of pharmacy benefit information to network pharmacies.
Meets department and CMS standards for preauthorization and override for members and providers.
Investigates and resolves Medicare pharmacy claim issues including reimbursement, benefit explanation, and complaint or problem resolution.
Provides additional support for the prior authorization of medications.
Provides support to multiple departments and committees to ensure the appropriate, cost-effective use of pharmaceuticals.

Minimum Qualifications

• Completion of Pharmacy Government Basic Customer Service Training
• Pharmacy Government Specialist I certification
• Demonstrated experience in a pharmacy or government benefits support role.
• Demonstrated ability to meet performance standards for a Pharmacy Government Specialist II
• Demonstrated ability to provide superior customer service
• Demonstrated ability to listen and communicate effectively
• Demonstrated ability to problem solve and work under pressure
• Demonstrated proficiency in navigating computer systems, typing, and technologies
• Demonstrated experience mentoring or training on pharmacy or government benefits

Preferred Qualifications

• Bachelor's degree. Education must be obtained from an accredited institution. Degree will be verified.
• Three years of professional experience with Medicare Part D.
• Computer skills including word processing, spreadsheet applications, and data base management.
• Professional attitude and behavior including handling stress well, working with a variety of health care professionals, and working through frequent interruptions.
• Excellent problem solving and autonomous decision-making skills.
• Functions well with minimal supervision.
• Demonstrated excellent verbal and written communication skills.
• Customer service experience and Medicare experience

Physical Requirements:

Interact with others requiring the employee to communicate information.
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Operate computers and other office equipment requiring the ability to move fingers and hands.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Anticipated job posting close date:

Location:

Work City:

Work State:

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment todiversity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.