- Full Time/Contract
- Rancho Cucamonga, CA
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company to Work For, "Favorite Training Program and "Favorite Workplace Culture in their 2014 Winning Workplaces survey.
MEDI-CAL PHARMACY CALL CENTER REPRESENTATIVE
Under the general direction of the Medi-Cal Pharmacy Call Center Supervisor, the Medi-Cal Pharmacy Call Center Representative is responsible for responding to Provider and/or Member calls in a friendly, professional manner. The Medi-Cal Pharmacy Call Center Representative must be able to utilize all policies and resources to answer questions and direct Providers/Members appropriately in order to resolve their concerns. The Medi-Cal Pharmacy Call Center Representative will need to demonstrate the ability to listen to Provider/Member concerns and questions and be able to accurately communicate health plan processes in a clear and knowledgeable manner.
- Communicate with Providers and Members (in English and Spanish) providing information and assistance as appropriate.
- Assist Providers with interpreting eligibility and benefit information.
- Assist with direction on the Company Provider webpage in regards to the Pharmaceutical Services Dept.
- Responsible for handling Argus claims status inquiries, researching and facilitating resolution of payment issues; provider education on formulary concerns and reimbursement issues.
- Provide assistance with Prior Authorization processing and online claim adjudication with the pharmacy providers.
- Provide assistance to members in regards to the Prior Authorization process or the status of their Prior Authorization request.
- Review and respond to interdepartmental tasks sent via CRM and coordinate the care of the member as necessary with the other departments such as Member Services, Health Ed, Care Management, Compliance, etc.
- Ability to effectively diffuse and assist disgruntled or irate callers.
- Handle on average 80-100 inbound/outbound calls per day while meeting or exceeding departmental standards and expectations.
- Provide excellent customer service to all callers. This includes, but is not limited to the following: demonstrating a high level of patience and respect with every caller, avoiding distractions to ensure each caller is assisted promptly and appropriately ensuring a positive provider/member experience.
- Promote LEAN environment and actively participate in LEAN activities in department and company wide basis.
- Any other duties as required to ensure Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined per Company policies and procedures relating to HIPAA compliance.
SKILLS & QUALIFICATIONS
- Possession of a high school degree or equivalent.
- Current California Pharmacy Technician License required.
- Minimum of one (1) year experience in a retail pharmacy setting.
- Knowledge in pharmaceutical terminology required.
- Knowledge of HMO operations in a managed care setting preferred
- Bilingual fluent Spanish preferred (oral conversational assessment will be performed).
- Ability and desire to handle 80-100 calls per day.
- Excellent written & verbal communication skills.
- Highly motivated and interpersonal skills.
- Understanding of and sensitivity to multi-cultural community.
- Strong organizational skills.
- Typing 45 words per minute, experienced in data entry.
- Proficient in MS Office applications.
- Telephone courtesy, high degree of patience, excellent in multi-tasking.
- Display the ability to adapt and perform duties efficiently whenever unexpected changes arise.
- Adherence to a specific work schedule is required.
- Works well in fast-paced environment.
COMPENSATION | POSITION CLASSIFICATION
- Full-Time | Contract