Claims Management - Pharmacy Benefits Advocate

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
 

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are.  Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

Summary

Under the supervision of the Manager of Pharmacy Benefits, the Pharmacy Benefits Advocate 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 position also assists with various internal tasks that ensure a high level of overall client satisfaction. On the job training will be provided.

Pharmastar (a Tabula Rasa HealthCare Group company) is a Pharmacy Benefits Manager (PBM) for commercial plans, Medicare Part D Plans and PACE Plans.

Essential Functions:

• 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, manual claims, reporting, enrollment activity, claims and pricing research.
• Attend department and company meetings and educational programs upon request.
• Ensures that HIPAA guidelines are followed in every communication with clients.

Qualifications:

• Associate’s degree preferred. High School Diploma or equivalent required.
• 1 year of customer service/member service experience in a call center or similar, required.
• Health care industry experience, a plus.
• CPhT (Certified Pharmacy Technician) certification, a plus.
• Experience in a pharmacy support role, a plus.
• Knowledge of plan and benefit structures and Medicare guidelines, a plus.

Knowledge, 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.

Supervisory Responsibility: None
 

Travel: None
 

Expected Hours of Work:

This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Shift is 930-6 CT

Physical Demands & Requirements:

• Communicates by way of the telephone with providers, participants, customers, and vendors; majority of the work day is spent communicating on the telephone
• Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
• Remains stationary for extended periods of time
• Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
• Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
• Occasional reaching to retrieve shelved items
• Occasional bending/stooping

Work Environment:

• This job operates in a professional office environment with a conversational noise level.
• No substantial exposure to adverse environmental conditions is expected.
• Moderate pressure to meet scheduled appointments and deadlines

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.