Pharmacy Member Experience Specialist

Now hiring a Pharmacy Member Experience Specialist

A Pharmacy Member Experience Specialist performs as a Presbyterian Pharmacy Services representative and as a Service Recovery Specialist and is responsible for providing customer service for members and providers for all PHP benefit plans. Specialists will ensure callers receive service excellence utilizing scripting, and critical thinking skills to assist with pharmacy questions or claims processing issues with regards to drugs and pharmaceuticals. The Pharmacy Member Experience Specialist will work to ensure members are highly satisfied with their prescription plan shown by improved Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, member satisfaction surveys and work to resolve any issues or concerns identified by our members. The emphasis is on providing patient-centered care to our members. They focus on improving the health outcomes of patients and providing access to medications and healthcare products in a more accessible and personalized way. Through this model, pharmacy technicians will provide individualized help, which may involve coordinating with other healthcare providers, and developing personalized plans to address each members unique needs and ensure members are taking their medications correctly to get the most benefit out of them. The goal of this Pharmacy Specialist is to provide our members with an extraordinary healthcare experience. By focusing on the individual, offering enhanced communication and personalized services, this will help ensure members receive the best care possible, which leads to better health outcomes and satisfaction with their benefits.

 

• Medicare CAHPS: We need our members to feel that it was always easy to:
• Use their prescription drug plan to get the medicines prescribed,
• To fill a Rx at my local pharmacy,
• To fill a prescription by mail
• To rate their prescription drug plan a 10 out of 10.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: No
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:  Minimum of 1 year Retail Pharmacy experience.  Minimum of 1-year Managed care customer service experience 

• GED or High School diploma is required.
• Certified Pharmacy Technician-PTCB (CPHT-PTCB)
• Drug Information skills

• Act as a subject matter expert to quickly and accurately resolve any calls or inquiries received by our Pharmacy Benefit Manager (PBM)
• Help members navigate formulary changes negatively impacted them or received a denial such as finding alternatives or initiating exceptions
• Facilitate prescription refills between PCP, pharmacy, and health plan (keep member out of the middle)
• Help members find lower cost medications and help members avoid cost surprises
• Coordinate finding medications when shortages occur
• Facilitate mail order set up
• Make outreach to new members that ask for us to contact them to help transfer prescriptions
• Make outreach / accept transfers from service recovery team members that uncover a need around prescriptions
• Utilize data from Mock surveys, new employer group onboarding, new Medicaid, and Medicare onboarding for members to identify members for targeted outreach.
• Utilize reject data to proactively outreach to those members and communicate benefits and formulary alternatives.
• Attend Medicare, Medicaid and Employer Group events to ensure proactive satisfaction with pharmacy benefits.
• Develop and maintain positive customer or partner relationships and acts as a member/patient advocate.
• Appropriately routes any issue(s) that require additional internal review to the correct
  department.
• Respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements. Is ready to take calls at the schedule time and spends the appropriate amount of time taking calls throughout their shift to resolve pharmacy related issues.
• Responds to questions or issues from PHP members and providers about pharmacy benefits, eligibility, coverage, terms and conditions, with respective benefit plans.
• Ability to analyze rejected pharmacy claims and identify resolution for successful claims submission and processing and respond to customer, partner or other PHS/PHP/Fluent business units to ensure accuracy of benefit interpretation with results within required timelines.
• Ability to use reference documents, such as D.A.R.T, Policies and Procedures and desktop procedures to complete tasks
• Ability to provide information to members and providers on issues related to benefit coverage, formulary, non-formulary criteria, or respective formulary coverage guidelines.
• Knowledge of drug nomenclature, basic pharmacology, dosage calculations, units of measure, prescription filling techniques, prescription documentation requirements, pharmacy laws and regulations, basic managed care pharmacy principles and insurance coverage issues.
• Knowledge of Pharmaceutical products, including oral, injectable, infusion products and chemotherapy drugs.
• Ease the way for prior authorizations
• Respond to member inquiries regarding prior authorization requests and provide specific details of authorization requirements and restrictions.
• Effective oral and written communication skills.
• Ability to meet established deadlines timely, accurately and with a sense of urgency
• Knowledge of Medical terminology and HIPAA regulations
• Other job duties as assigned by PHP Pharmacy Services Leadership
  
  

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $22.37/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.