Job description

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

Worker Type:

Regular

Exemption Status:

Job Summary:

Assists Pharmacy Customer Service leadership in processing provider, and member prior authorization requests. Works with the pharmacy team in implementing policies to manage pharmacy benefits.

Job Duties:

Maintains understanding of all policies and procedures related to the pharmacy benefit.
Provides the highest level of customer service and support to members and physicians.
Adheres to all regulatory standards.
Works with Pharmacists to resolve clinical issues with providers in a timely manner.
Documents accurately all inquiries and prior authorization requests according to departmental policy.
Determines appropriateness of pharmacy benefits under corresponding lines of business.
Contacts providers and members to communicate the details of service, requests additional information and resolves outstanding matters.
Updates current pharmacy benefits and serves as a facilitator to team members.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details:

Hours: 9:00am - 5:30pm

Weekend / Holiday Rotation

Internet requirements:

Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:

•25 MBPS UP
•75 MBPS DOWN
•<150 ms Ping Required
•<30ms Jitter Required

Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection

Education:

High School Diploma or Equivalent (GED)- (Required)

Experience:

Minimum of 2 years-Customer Service (Required)

Certification(s) and License(s):

Skills:

Communication, Customer Retentions, Customer Service, Customer Support Policies, Standards And Procedures

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
EXCELLENCE: We treasure colleagues who humbly strive for excellence.
LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

Required profile