Pharmacy Claims Help Desk Specialist

About AnewHealth

AnewHealth is one of the nation’s leading pharmacy care management companies, specializing 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

The Pharmacy Claims Help Desk Specialist is responsible for answering calls from our clients and providing timely and accurate responses in a professional and courteous manner. This position works with internal and external clients which include members, clinicians, pharmacies, plan sponsors, and other departments within the company. This role also assists with various internal tasks that ensure a high level of overall client satisfaction. On-the-job training will be provided.

Responsibilities

• 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.
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
• Participate in on-call rotation.
• Accept other duties as assigned; including but not limited to: direct member reimbursement, processing, manual claims, reporting, and researching rejected claims.
• Attend department and company meetings and educational programs upon request.
• Ensure that HIPAA guidelines are followed in every communication with clients.
• Express interest in learning new tasks for development purposes.
• Embody AnewHealth’s Core Values in all communications and interactions.
• Other duties as assigned.

Qualifications

Education

• Associate’s degree preferred. High School Diploma or equivalent required.
• CPhT (Certified Pharmacy Technician) certification, a plus.

Experience

• 1 year of customer service/member service experience in a call center or similar, required.
• Health care industry experience, a plus.
• Experience in a pharmacy support role, a plus.
• Knowledge of plan and benefit structures and Medicare guidelines, a plus.

Skills & Abilities

• 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.

Schedule, Travel, and Benefits

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

Key skills/competency

• Customer Service
• Claims Processing
• Prior Authorization
• Medicare Part D
• HIPAA Compliance
• Pharmacology
• Call Center Operations
• Problem Solving
• Data Entry
• Client Education