CALL CENTER REPRESENTATIVE - PDP PRIOR AUTHORIZATION

Location: Baltimore, MD

POSITION SUMMARY:

Representative is responsible for taking inbound calls from providers and pharmacies seeking prior authorizations for various drugs.  Representative is also responsible for outbound calls for MTM services, compliance monitoring, and address verification.  Representative may also be responsible for entering case decisions into the case tracking system as well as entering the appropriate authorizations into the Medco system.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

·          Takes inbound calls from providers and pharmacies

·          Makes outbound member calls for MTM services

·          Be able to interpret the problem the caller is inquiring about and suggest the appropriate course of action

·          Interpret information from various systems and determine the appropriate course of action based on

·          departmental policies and procedures.

·          All other duties as assigned

Minimum qualifications:

·          High School Diploma

·          1-2 year’s previous pharmacy call center experience or have 1-2 year’s previous pharmacy technician experience in a retail environment.

KNOWLEDGE, SKILLS AND ABILITIES:

·          Must be able to speak clearly and be understood while on the phone.  Must be courteous and succinct when dealing with inbound and outbound callers.  Must be familiar with both technical terms as well as clinical terms that may be used by various health care professionals and other callers.

·          Must be able to solve problems from incoming callers with a minimum of information by using the real time systems available.

·          Must be able to follow policies and procedures as they relate to both customer service as well as clinical criteria.

·          Must be familiar with Windows environment and have previously used a PBM computer interface system.  Retail pharmacy software experience is a plus.

·          Must be able to work additional hours as workload dictates during peak call volume months of January through April of each year.