We're always looking for people with the following skills... Pharmacist - Prior Authorization Member Support Representative (Remote)
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Member Support Representative (Remote)
10845 Griffith Peak Dr, Las Vegas, NV 89135, USA
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Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work. If putting a smile on someone’s face puts one on yours, you belong on our team.
Here at TransparentRx, we’ve brought together teams of incredibly compassionate and absolutely positive people to help serve our members when they call us with questions regarding their health care coverage, eligibility, or reimbursement. Your helpful personality combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while building a career.
The PBM Member Support Representative answers inbound customer support calls and provides appropriate responses, guidance and/or solutions in a timely manner to members and/or patients, pharmacists, and physicians. This position is full–time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours (8:00am – 11:00pm ET). It may be necessary, given the business need, to work occasional overtime and weekends. This is a telecommute (work from home) role based within the United States. Starting pay is $18.00 - $20.00 per hour plus bonus.
This role is equally challenging and rewarding. You will be called on to research complex issues across multiple databases. It requires fluency in computer navigation and toggling while you confidently and compassionately engage in dialogue with the caller. Be assured that our training will provide you with knowledge of the various products, plans and levels of benefits available to members and you will soon find yourself creating positive experiences and earning the gratitude of callers on an hourly basis.
A high school diploma or GED is required. Certified Pharmacy Technician (CPhT) or bachelor's degree is preferred.
Pharmacist - Prior Authorization
10845 Griffith Peak Dr, Las Vegas, NV 89135, USA
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Company Overview:
TransparentRx is a revolutionary Pharmacy Care Management company headquartered in Las Vegas, Nevada designed by industry experts to address major gaps in today’s PBM marketplace. We created an innovative company focused on lowering pharmacy costs, delivering concierge service, and providing superior clinical care that strategically aligns with members, clients, and their benefit advisors.
Our goal is to simplify pharmacy benefit solutions and deploy best-in-class products to achieve our clients’ objectives.
Position Summary:
TransparentRx has created an innovative approach to Pharmacy Benefit Management. As a Pharmacist - Prior Authorization, you will work remotely in a business environment where strict work guidelines are employed. As a Pharmacist - Prior Authorization, you will be responsible for evaluating Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.
Responsibilities:
• Work in computer based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
• Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
• Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
• Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
• Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
• Conform with and supports department quality assurance and improvement guidelines
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of TransparentRx
• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team
Qualifications:
• We are seeking a pharmacist with at least five (5) years of pharmacy experience working for a leading Health Plan or PBM with an industry track record of highly managed clinical pharmacy benefit management strategies. Candidates should be willing to work in a start-up environment where responsibilities may vary from day to day
• At least three (3) years of experience in analyzing raw prescription claims data in Excel
• Extensive knowledge of inner working of PBM or Health Plan pharmacy program preferred
• Knowledge of PBM and pharmacy services contracts and contracting process preferred
• Deep knowledge of highly managed specialty medications/strategy, formulary development and maintenance process, including rigorous evaluation of pharmaceutical products and ranking products based on value
• Excellent written and oral skills, both in developing materials and presenting to senior clients
• Desire to work in a fast-paced, exciting start-up environment with the ability to multi-task and work outside the non-clinical environment
• Superior written and oral presentation skills; face to face client interaction is essential
• Exceptional clinical, business and relationship building skills and must possess the ability to apply sound clinical judgment to a variety of situations
• Knowledge and ability to participate in the pharmacy benefits sales process
• Proficient in Microsoft Office Suite
• Ability to travel occasionally
Compensation:
• Industry leading compensation with competitive base salary and annual bonus based on performance
• Ability to work from home
About Us
Founded in 2009, TransparentRx helps unions, health plans, health systems, commercial and public sector employers reduce pharmacy costs, up to 50%, without cutting benefits or shifting costs to employees. TransparentRx provides a fully transparent and fiduciary pharmacy benefit management service, which means only an administrative fee (our sole source of revenue) is earned for processing and managing our clients' pharmacy benefits.
Here are some of the benefits of the fiduciary business model offered by TransparentRx:
- We guarantee clients pay $78 PMPM or less
- We make it easy to reconcile paid claims with invoices
- We connect with any TPA and do the heavy lifting
- 65,000+ retail pharmacy network
- Specialty and Mail Pharmacy
- In-house alternative funding program
- Medication Therapy Management (MTM) Program
- Pharmacogenomics Program
In addition, TransparentRx offers companies the opportunity to maximize drug spending internally through our Certified Pharmacy Benefits Specialist (CPBS®) designation. Our students develop a strong understanding of pharmacy benefit management, including how to develop an overarching pharmacy benefit strategy and understanding the landscape of the various domains. These newly acquired skills are then transferred to your organization, making the pharmacy benefit less costly and more measurable.
