Client Relationship Specialist

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

Under the supervision of the Manager of Client Relationship, the Client Relationship Specialist is responsible for acting as a first-line resource for external clients regarding Pharmastar’s product lines, including (but not limited to) Medicare and Commercial prescription drug data, ensuring the necessary information is disseminated to the applicable resources within the organization. Candidate will demonstrate proficiency with resolutions of all common issues, questions and solutions.

Responsibilities

• Serve as main contact for external clients requesting products (Medicare D and Commercial).

  • Requests include but are not limited to: formulary compliance, plan set-up, provider management, member enrollment/eligibility changes, patient concerns, reporting (scheduled and ad hoc), audit support, and claims assistance.

• Perform client outreach and set up recurring calls.

• Serve as main contact for submission of internal workload requests to the Manager;

• Prepare, submit, and analyze PDE submissions to CMS;

• Research and suggest solutions for submission rejects;

• Assist in the reconciliation of PDE data;

• Summarize and report PDE progress;

• Support clients in all areas of Part D functions for compliance with regulatory requirements.

• Coordinate the submission of regulatory reporting to the appropriate management and governing agencies to ensure critical deadlines are met;

• Track all applicable regulatory updates and changes for incorporation into policies and procedures;

• Act as a first-line contact to external clients and assist in answering questions and/or triaging concerns to other associates.

• Build strong, trusting relationship with clients and its pharmacies.

• Present company product line services to clients as needed.

• Ensures that HIPAA guidelines are followed in every communication with clients.

• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.

• Attend department and company meetings and educational programs upon request.

• Assist with answering Help Desk calls when needed.

• Perform administrative duties as required.

• Other projects as assigned.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job.  Not all of the duties may be assigned to a position.

Qualifications: These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

• Bachelor’s degree preferred. Associate’s degree or formal training beyond high school, required.

Experience

• 3+ years of customer service and industry experience. (Health plan or insurance experience, a plus. PBM experience preferred.)

• CPhT (Certified Pharmacy Technician) certification, a plus.

• Experience in a pharmacy support role, a plus.

• Current on plan and benefit structures and Medicare Part D guidelines.

Skills & Abilities

• Demonstrated proficiency with resolution of all common issues, questions and solutions.

• 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.

• Detail oriented and able to prioritize workload.

• Strong computer skills including using word processors, spreadsheets, and database software.

Physical/Mental Demands: This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within assigned territory. May be necessary to work extended hours as needed.

Schedule: This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Travel: Travel may be required for special organization or department events, department team meetings, trade shows, conferences, and other client engagements.

This is a remote position.

AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.