Pharmacy Benefits Specialist

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👩‍👩‍👧‍👦 Human Resources (HR)

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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ExactCare

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

Healthcare • 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 • Provide timely and accurate responses to clients, including members, clinicians, pharmacies, plan sponsors, and internal departments • Document incoming calls and dialogue in claims adjudication software • Educate clients on plan policies, benefits, and procedures • Resolve medical, financial, or technological drug benefit concerns • Initiate and facilitate prior authorization requests • Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets • Review after-hours call logs and complete follow-up as needed • Submit JIRA tickets for compound prescriptions • Submit JIRA tickets to resolve NDC issues, including pricing issues and missing NDCs • Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines • Perform direct member reimbursement, processing, manual claims, reporting, and rejected-claim research as assigned • Ensure HIPAA guidelines are followed in every client communication • Embody AnewHealth’s Core Values in communications and interactions • Travel to special organization or department events, team meetings, trade shows, conferences, and other client engagements when required

🎯 Requirements

• Associate’s degree or equivalent combination of education or work experience • Preferred CPhT (Certified Pharmacy Technician) Certification • Minimum 3 years of customer service/member service experience in a call center or similar environment • Minimum 2 years of experience in the healthcare industry • Minimum 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 • Availability outside of normal business hours on an ad-hoc basis • Ability to work scheduled hours from 11:30am to 8:00pm Eastern Standard Time • Applicants must be eligible to work in this country

🏖️ Benefits

• Medical, dental, and vision coverage • Flexible spending account • Company-paid life insurance • Short-term disability coverage • Voluntary benefits • 401(k) • Paid Time Off • Paid holidays • Remote work arrangement