Pharmacy Medicare Specialist

Job Description:

The Pharmacy Government Specialist II is responsible for the day-to-day operations of Government programs, providing superior customer service to all inquiries and questions for members, providers, employer groups, facilities, and other departments and teams. This position provides superior customer service consistent with policies, company values, and quality standards. The incumbent resolves customer issues on the initial call or provides timely follow-up when additional research is needed. This position complies with established criteria for response time, handling time, availability, and call flow as well as established auditing criteria. The Specialist II stays current and conversant on general plan design and modifications to provide accurate and appropriate information. This position maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy. The incumbent maintains customer history in member tracking using correct codes and detailed comments. This position educates callers on correct use of their plans including coverage of benefits, utilization, and administrative guidelines in collaboration with teammates and other departments.

Schedule

• Monday-Friday
• 8am-4:30pm or 8:30am-5:00pm

​Job Essentials

• Maintains the confidentiality of member's 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 and Government forms,
• True Out Of Pocket (TrOOP) status, and the formulary transition process.
• Assists Medicare and Medicaid members with grievances, coverage determination (including exceptions), and appeals process.
• Required to meet all department standards pertaining to call statistics, production, documentation, quality and accuracy.
• Meets department and CMS standards for prior authorizations and override for members and providers.
• Follows established CMS guidelines to complete prior authorizations, which include member and provider notification standards.
• 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 Government 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 Government pharmacy claim issues including reimbursement, benefit explanation, and complaint or problem resolution.
• Additional responsibilities as needed including indexing, claims processing, handling escalated issues, Medicaid restrictions, Coordination of Benefits (COB), general reports, needs more information (NMI) requests and oral prior authorization requests

Minimum Qualifications

• 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

• Current National Pharmacy Technician certification.

Skills

• Pharmacy
• Pharmacy Benefits Management (PBM)
• Medical Prescriptions
• Pharmacy Claims
• Call Center
• Customer Service
• Problem Resolution
• Phone Calls (Inbound/Outbound)
• Oral Communication
• Written Communication
• Group Problem Solving
• Medicare Part D
• Medicaid
• Mentorship/Coaching
• Decision Making

Physical Requirements:

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

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

$26.28 - $39.98

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 package here.

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.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.