- Hingham, Massachusetts, United States
- Full-time
- $22–$27 per hour
The Pharmacy Operations Representative is responsible for primary contact for our providers to obtain authorization for retail pharmacy, home infusion and medical utilization management requests.
Compensation
Hourly Range: $22.43 - $27.42
Responsibilities
- Receive, process, and archive provider’s retail fax and phone authorization requests accurately using multiple computer systems against our Medical Policy Criteria.
- Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email.
- Analyze and interpret high level medical data and accurate data entry information according to NCQA guidelines.
- Receive, process, and archive Home Infusion Therapy and Utilization Management Medical requests accurately using MHK and other systems via fax or telephone.
- Communicate determinations to providers via incoming and outgoing telephone calls.
Requirements
- High school diploma required
- Associate or Bachelor’s degree preferred
- Nice to have: Associate degree
- Nice to have: Bachelor’s degree