Pharmacy, Associate, Pharmacy Specialist #910
Status: Full-time, Non-Exempt
This position will help licensed pharmacists take care of many of the daily operations of the pharmacy department. This is including, but not limited to: calling providers, members, and pharmacies; having knowledge of pharmacy benefits for MVP’s multiple lines of business, formularies, and policies; providing drug-related information to Customer Care Center and other internal departments; managing incoming faxes requesting drug coverage; determining eligibility and evaluating pre-authorization requirements using multiple systems; obtaining additional information and initiating cases for review when appropriate for multiple lines of business; preparing cases for review by Pharmacists; requesting additional clinical information for case completion from provider via verbal and fax requests; completing case files by creating member/provider written notifications and making outgoing calls to provide members/providers with determinations; creating and monitoring timeframe activity reports at least daily or more frequently as applicable and escalating cases with impending timeframes; ensures that regulatory timeframes are met using learned knowledge and daily tracking; creating and maintaining reports using MS Excel, Access, and other reporting tools; loading different types of authorizations and testing for accuracy; supporting the Medicare MTM program by utilizing communication skills such as motivational interviewing to gain agreement from members to participate in comprehensive medication reviews (CMR); perform special projects, and is cross-trained in selected functions, as assigned. Performs other duties as assigned.
This position will require weekend work on a regular or rotating basis and holiday work as assigned. Daily hours range from 8:30 - 5:00 pm or 9:30 – 6:00 pm as assigned. Schedules are subject to change based on business need.
AAS degree preferred or equivalent combination of education and experience required.
Completion of Pharmacy Technician course preferred.
1-2 years of data entry experience
1-2 years of customer service experience resolving complex customer inquiries
Related to required minimum experience above, relevant insurance, medical or healthcare experience involving prescription medication services is highly preferred
Strong written and verbal communication skills using different tools (email, fax, phone, etc.)
Strong data entry skills with superior attention to detail
Moderate to strong computer literacy with proficiency in MS Word, Excel, and Outlook
Flexibility to adapt to changing environment and/or workflow processes on a day-to-day basis
Ability to excel in a fast-paced, deadline-oriented position using superb time management skills
Ability to work independently in a team environment with desire to help others
Maintains professional approach in workplace with strong interpersonal skills.
Strong desire to learn, improve and adhere to complex processes as defined
Excellent customer service skills and ability to deal with stressful calls in a professional manner
Familiarity with healthcare benefits, pharmacy and medical terminology
Previous experience requiring strict adherence to confidentiality
Ability to sit at workstation for long periods of time in front of computer
Ability to multi-task using multiple computer systems and prioritize work
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at email@example.com