Intermountain Healthcare Pharmacy Helpdesk Medicare Specialist - SelectHealth in Salt Lake City, Utah

Job ID:205978
Greater Salt Lake area

About Us

What does it mean to be a part of Intermountain Healthcare? It means that the quest for clinical excellence is not just a goal, but a given. It means building an environment where physicians and employees can deliver the best in healthcare. And it’s realizing each employee or volunteer is vital to the healing process, because we can only achieve theextraordinary together .

Being a part of Intermountain Healthcare means joining with a world-class team of over 36,000 employees and embarking on a career filled with opportunities, strength, innovation, and fulfillment. Our mission is: Helping people live the healthiest lives possible.

Our patients deserve the best in healthcare, and we deliver.

Job Description

Do you want to make a difference in someone’s life? Our mission is to help people live the healthiest lives possible. Do you want to work in an environment where you can focus on superior service? Our Pharmacy Helpdesk Medicare Prior Authorizations Specialist position offers you an opportunity to provide extraordinary customer service to SelectHealth Advantage members while educating them on their pharmacy benefits and the correct use of their plans.

Responsibilities: Reviews medication for prior authorization and exception requests according to CMS guidelines. Specialists will outreach to physicians, pharmacies, and members to obtain additional information when necessary. Specialists will also be required to notify members and physicians of plan decisions by phone and fax. Specialists will occasionally be responsible for answering incoming calls from SelectHealth Advantage members, providers, and pharmacies. Specialists will increase members understanding of insurance benefits, communicate status of claims payment, and complete outbound calls to other entities on behalf of the member. Specialists are responsible to create a superior service experience to SelectHealth Advantage customers.

Essential Job Duties

  • Receives incoming calls from members, providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values, and quality standards.
  • Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy.
  • Maintains customer history in member tracking using correct codes and detailed comments.
  • Utilizes several applications and tools to respond to inquiries regarding pre and post enrollment, benefits, cost sharing, Medicare forms, True out of cost care (TrOOP) status, and the formulary transition process
  • Assists Medicare members with the Part D grievance, coverage determination (including exceptions), and appeals process
  • Ensures all department standards are met pertaining to call statistics, production, documentation, and quality / accuracy.
  • Receives escalated calls regarding specific Medicare Part D questions or issues
  • Pursues excellence by continually looking for ways to improve processes and systems. Acts as a resource to Pharmacy Benefits Claims staff, and assists in training and documentation at the supervisor's request.
  • Acts as a mentor and willingly coaches and develops others and provides effective feedback.
  • Takes escalated calls in the supervisor's absence and handles them in a professional and courteous manner.
  • Represents and participates in Medicare meetings or projects as assigned by supervisor.
  • Aides in the dissemination of pharmacy benefit information to network pharmacies.
  • Meets department and CMS standards for preauthorization and override for members and providers.
  • Follows established CMS guidelines to complete Medicare pre-authorizations, which include member and provider notification standards.
  • Investigates and resolves any Medicare pharmacy claims issues including reimbursement, benefit explanation, and complaint / problem resolution.
  • Works to provide additional support for the prior authorization of medications.
  • Provides support to multiple departments and committees to ensure the appropriate cost-effective use of pharmaceuticals.

Posting Specifics

  • Entry Rate: $19.00/hour or more, depending on experience.
  • Benefits Eligible: Yes
  • Shift Details: Full-time, 40 hours per week. Monday through Friday, one rotating Saturday (9:00 am to 2:00pm) every four weeks.
  • Department : Medicare Pharmacy Operations - SelectHealth, located in Murray, Utah.
  • Additional Details: Shifts may occur during department hours of Monday through Friday 7:30 am to 8:00 pm. Rotating weekends (approximately every fourth week) – Saturday 9:00 am to 2:00 pm and an on-call Sunday. Some holidays may be required. Due to Medicare guidelines and annual enrollment, there are periods of blackout and no PTO will be approved, normally between October 15th - February 15th

Minimum Requirements

  • Three years customer service combined experience in a managed care setting, customer service representative, pharmacy technician, pharmacy, or medical benefits.
  • Twoyears of experience in pharmacy insurance or health insurance.
  • One year experience with Medicare(could include processing Medicare insurance, answering questions and/or assisting customers regarding Medicare enrollment, plans, claims, etc. Medicare experience can include medical plans or Part D.)

Physical Requirements

  • Listening, hearing, speaking, manual dexterity

Preferred Requirements

  • Bachelor's degree.
  • Three years of experience with Medicare Part D.
  • Computer skills with word processing, spreadsheet applications, and data base management.
  • Professional attitude and behavior including the ability to handle stress well, work with a variety of health care professionals, and work through frequent interruptions.
  • Excellent problem solving, autonomous decision making abilities, and ability to function with minimal supervision.
  • Demonstrated excellent verbal and written communication skills.

Please Note

All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Additional Details:

Working Hours 40

Primary Work Location SelectHealth

Expertise Pharmacy

Job Type Full Time

Location US-UT-Murray, US-UT-Salt Lake City