What are the responsibilities and job description for the Pharmacy Operations Representative - Medicaid position at Health Care Service Corporation?
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 pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims. 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.
Job Requirements
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.
LI-FW1
Sponsorship is not available
Compensation: $38,100.00 - $80,000.00
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
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 pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims. 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.
Job 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.
- 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.
- 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.
- Facilitate process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services.
- Available during core business hours Monday – Friday 8:00 AM – 5 PM MST and commute into Albuquerque, NM office.
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.
- Must be a Current Licensed/Certified Pharmacy Technician
LI-FW1
Sponsorship is not available
Compensation: $38,100.00 - $80,000.00
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
Salary : $38,100 - $80,000