Pharmacy Benefits Specialist

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🔥 9 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👩‍👩‍👧‍👦 Human Resources (HR)

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ExactCare

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

Healthcare Insurance • Pharmaceuticals

ExactCare is a leading pharmacy care management provider that specializes in medication management for individuals with complex, chronic medical needs. With operations in all 50 states and Washington, D. C. , ExactCare supports more than 100,000 people nationwide, helping them manage their medications in assisted living, long-term care facilities, and at home. Partnering with healthcare organizations, ExactCare aims to improve clinical outcomes by ensuring better medication adherence, reducing readmissions, and lowering overall healthcare costs.

📋 Description

• Answer telephone inquiries in a pleasant, professional, and efficient manner assuring exceptional customer service • Document all incoming calls and dialogue in the claims adjudication software • Educate clients on plan policies, benefits, and procedures • Resolve client drug benefit concerns of a medical, financial, or technological nature • Initiate and facilitate prior authorization requests • Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets • Review after hours calls log-complete any follow up as needed • Submit JIRA tickets for compound prescriptions • Submit JIRA tickets to resolve NDC issues (pricing issues, missing NDCs) • Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines • Accept other duties as assigned; including but not limited to direct member reimbursement, processing, manual claims, reporting, and researching rejected claims • Ensures that HIPAA guidelines are followed in every communication with clients • Embody AnewHealth’s Core Values in all communications and interactions

🎯 Requirements

• Associate’s degree or equivalent combination of education or work experience • CPhT (Certified Pharmacy Technician) Certification preferred • A minimum of 3 years of experience in customer service/member service in a call center or similar • A minimum of 2 years of experience in the healthcare industry • A minimum of 2 years of experience in a pharmacy support role • Knowledge of plan and benefit structures and Medicare guidelines • Knowledge of pharmacology and pharmacological terms • Excellent communication skills and professionalism when working with clients • Ability to solve problems under pressure by making immediate decisions while on the phone • Detail oriented and able to prioritize workload • Strong computer skills including using word processors, spreadsheets, and database software

🏖️ Benefits

• Medical/dental/vision coverage effective 1st of the month following date of hire • Flexible spending • Company-paid life insurance • Short-term disability • Voluntary benefits • 401(k) • Paid Time Off • Paid holidays