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Independent Health Association, Inc. Pharmacy Customer Service Representative in Williamsville, New York

Overview
The Pharmacy Service Technician (PST) is a customer service professional
who displays confidence, a passion for service, and practices empathetic
listening towards all Pharmacy Benefit Dimensions (PBD) customers. The
PST functions as an advocate for all customers and resolves all
inquiries (i.e. phone, mail, fax and email.) They will utilize system
tools and resources to address and resolve inquiries; provide benefit
clarification and eligibility; communicate claim and reimbursement
information, facilitate proper utilization of policies and procedures,
coordinate resolution to streamline processes; make demographic changes;
and educate customers on regulatory policies and procedures.
Qualifications

High School or GED required; Associate's degree preferred.

One (1) year of experience in a member/call center operations
environment combined with either one (1) year experience handling
self-funded pharmacy calls or one (1) year of pharmacy experience
required OR two (2) years of pharmacy experience required.

Demonstrated ability to effectively communicate with internal and
external customers. Excellent written/verbal communication skills,
excellent customer service skills.

Experience handling high volume, inbound and outbound phone calls
preferred.

Demonstrated ability to listen with intent to understand.

Demonstrated proficiency to verbally translate written communication.
Typing 35-40 words a minute required.

Demonstrated proficiency in problem-solving and proven ability to
prioritize accordingly.

PC and Windows experience with proficient typing skills and ability to
utilize multiple system tools simultaneously.

Strong organizational/time management skills.

Proven examples of displaying the PBD values: Trusted Advisor,
Innovative, Excellence, Guardianship, Dedication and Caring.
Essential Accountabilities
Servicing

Responsible for acting as a customer advocate by providing excellent
customer service when answering customer phone calls, written
correspondence and servicing walk-in members in a timely fashion.
De-escalate customers as needed and resolve customer complaints.

Ensure that our customers are obtaining accurate and up-to-date
information on policies and procedures and communicate a successful
resolution to inquiries.

Ensuring compliance with all CMS rules and regulations.

Log all contacts into appropriate systems.

Meet or exceed all department standards in the following categories as
measured and recorded the representative's scorecard:

Quality goals - measure Representative's ability to consistently respond
to customers with excellent customer service.

Productivity goals - measure Representative's ability to be productive
and use time effectively and efficiently. Includes average talk plus
hold time, after-call work (ACW), adherence, use of non-available
states, tardiness and attendance.

Accuracy goals - measure Representative's ability to respond to
inquiries correctly and accurately.

Technical Proficiency

Maintain technical knowledge regarding Pharmacy Benefit Dimensions'
contracts and benefits and working knowledge of policies and procedures
and maintaining updates on a daily basis. Attend required training
sessions as needed.

Provide accurate and up-to-date information to all customers by
documenting all pertinent information into appropriate systems to meet
regulatory agency standards (NCQA, State, CMS etc.), addressing first
level complaints and providing assistance on appeals as needed; receive
and effectively resolve written inquiries from members regarding claims,
benefits, eligibility, reimbursement and participating providers.

Knowledge of all systems (Siebel, HealthRules, RxClaim, Macess, Reveal,
E-mail and other systems as needed) and training manuals and the ability
to coordinate the use of these tools at the same time.

Administrative Duties

Other duties as required by immediate supervisor which may include
servicing walk-in members, correspondence support and making outbound
phone calls.

As an Equal Opportunity / Affirmative Action Employer, Independent
Health and its affiliates will not discriminate in its employment
practices due to an applicant's race, color, creed, religion, sex
(including pregnancy, childbirth or related medical conditions), sexual
orientation, gender identity or expression, transgender status, age,
national origin, marital status, citizenship, physical and mental
disability, criminal record, genetic information, predisposition or
carrier status, status with respect to receiving public assistance,
domestic violence victim status, a disabled, special, recently
separated, active duty wartime, campaign badge, Armed Forces service
medal veteran, or any other characteristics protected under applicable
law. for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.

As an Equal Opportunity / Affirmative Action Employer, Independent
Health and its affiliates will not discriminate in its employment
practices due to an applicant’s race, color, creed, religion, sex
(including pregnancy, childbirth or related medical conditions), sexual
orientation, gender identity or expression, transgender status, age,
national origin, marital status, citizenship, physical and mental
disability, criminal record, genetic information, predisposition or
carrier status, status with respect to receiving public assistance,
domestic violence victim status, a disabled, special, recently
separated, active duty wartime, campaign badge, Armed Forces service
medal veteran, or any other characteristics protected under applicable
law. Click here:
https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation
for additional EEO/AAP or Reasonable Accommodation information.

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