Pharmacy Help Desk Representative

Independent Health, a not-for-profit health plan headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio of progressive products include HMO, POS and EPO products, Medicare and Medicaid plans, traditional indemnity insurance, individual and small group Exchange products, consumer-directed plans and health savings accounts, plus coverage for self-funded employers. Independent Health has augmented its highly successful insured product portfolio with services employers and employees need to better manage their health care expenses through its affiliate companies, including the Independent Health Foundation, Pharmacy Benefit Dimensions, Reliance Rx and Nova Healthcare Administrators. To see more about how Independent Health works to improve the health and well-being of our community, including in-kind volunteer service of our associates and other corporate resources, please click here to view our Community Benefit Report. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us. Independent Health and its family of companies are a drug-free workplace. Candidates are required to pass a drug test before beginning employment. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Talent Acquisition at: HR@independenthealth.com or (716) 635-4800 FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion. Overview The Pharmacy Help Desk Representative will be responsible for providing assistance to our pharmacies as well as internal servicing representatives in addressing and resolving pharmacy issues regarding reimbursement, proper utilization of policies and procedures and coordinating resolution to streamline the process through pharmacy education. These individuals must maintain our goals in achieving service levels and increasing the pharmacist satisfaction rate, the pharmacy help desk representative will function as a pharmacy advocate. These individuals will also assist with the entry of prior authorization and other projects and assignments to support the pharmacy department including assisting with the training of new pharmacy help desk representatives. Occasional holidays, weekends, overtime and on-call responsibilities are a requirement of the position. Qualifications High School diploma or GED required; Associates degree preferred. Six (6) months experience handling self-funded pharmacy calls or working for a health insurance company or physician’s office interacting with pharmacies; OR pharmacy tech certification required. General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging. Excellent written and verbal communication skills and problem-solving skills required, including the capability to absorb new concepts. PC and Windows experience required, including typing skills. Familiarity with on-line claim systems preferred. Demonstration of math aptitude for purposes of calculating simple drug requirements when given dosing and price calculations. Proven examples of displaying the Pharmacy Benefit Dimensions (PBD) values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring. Essential Accountabilities A. Customer Servicing Responsible for answering all types of provider phone calls and written correspondence in a timely fashion, with minimal supervision by a manager. They will ensure that our providers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries. All calls to be logged into call documentation systems. Responsible for answering and documenting inquiries by internal customers including, but not limited to our servicing representatives and sales representatives. Responsible for being logged in and ready to take calls at the start time of their shift. Exercise a courteous, efficient, respectful and timely response to all internal and external customers. Attend customer service training sessions and additional pharmacy system training as needed. “On-call” responsibilities on a rotating basis. In addition to assisting PBD departments with employee training, the pharmacy help desk representative will assist with check and voucher questions and special projects as determined by their immediate supervisor and management staff. B. Technical Proficiency Maintain technical knowledge regarding Independent Health and PBD pharmacy contracts and benefits and working knowledge of policies and procedures, department lists, and maintaining updates on a daily basis. The Pharmacy Help Desk Representative will assist in interpreting database information as it relates to pharmacy claims processing. Assist with PBM implementation by identifying potential issues and entering prior authorizations to reduce/avoid disruption and ensure smooth transition for new PBM plans/members. Assist the Pharmacy systems department with various data entry projects/information as they relate to pharmacy claims processing. C. Administrative Duties Provide accurate and up-to-date information to all pharmacy providers by documenting pertinent information into Siebel; assist other departments in responding to questions from any pharmacy department mailing. Assist with preparation (triaging), logging in and logging out of authorization requests during evening and weekend shifts. In addition, if the authorization area of the pharmacy department needs additional assistance during the day, the Pharmacy Help Desk Representative will assist when requested by immediate supervisor or other pharmacy department management staff. As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information. Current Associates must apply internally via their Career Worklet.