Pharmacy Benefits Specialist

Anew Health 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 Exact Care and Tabula Rasa Health Care, 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 Customer Support 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.

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.

Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets.

Review after hours calls log-complete any follow up as needed.

Submit JIRA tickets for compound prescriptions.

Submit JIRA tickets to resolve NDC issues (pricing issues, missing NDCs)
Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.

Accept other duties as assigned; including but not limited to direct member reimbursement, processing, manual claims, reporting, and researching rejected claims.

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

Embody Anew Health’s Core Values in all communications and interactions.

Other duties 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 Required:

Associate’s degree or equivalent combination of education or work experience.

Preferred: CPhT (Certified Pharmacy Technician) Certification.

ExperienceA minimum of 3 years of experience in customer service/member service in a call center or similar.

A minimum of 2 years of experience in the healthcare industry.

A minimum of 2 years of experience in a pharmacy support role.

Knowledge of plan and benefit structures and Medicare guidelines.

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:

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…