Claims Management - Pharmacy Benefits Lead

About Us
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications provide solutions for a range of payers, providers, and other healthcare organizations. We’re on a mission to enable simplified and individualized care that improves the health of those we serve.

We’re looking for people who are excited to drive this transformation. To break barriers and think of new ways to adapt, help, and create better experiences for patients—and for each other. This is where diverse backgrounds, beliefs, and perspectives matter and where “care” is centric to who we are. Come do more than join something, change something. For patients, for their families, for the future of healthcare.

Job Title: Pharmacy Benefits Lead (Helpdesk)

Reports to: Manager of Pharmacy Benefits

Summary

Under the supervision of the Manager of Pharmacy Benefits, the Pharmacy Benefits Lead is responsible for assisting with the oversight and operations of the Pharmacy Benefits staff and being the team SME. The team is responsible for answering calls from our clients and providing timely and accurate responses in a professional and courteous manner. This position works with internal and external clients which include: members, clinicians, pharmacies, plan sponsors and other departments within the company. Candidate will demonstrate ability to provide consistently solid service and has developed expertise in products and services.

The Pharmacy Benefits Lead is responsible for assisting with new hires and training, develop processes and procedures, solving escalated issues with clients, and help identify areas for improvement. This position also assists with various internal tasks that ensure a high level of overall client satisfaction.

Pharmastar (a Tabula Rasa HealthCare Group company) is a Pharmacy Benefits Manager (PBM) for commercial plans, Medicare Part D Plans and PACE Plans.

Essential Functions:

• Assist with new hire set-up.
• Assist with new hire training schedule.
• Create onboarding and exit process for team members.
• Collaborate and develop ongoing training for entire Pharmacy Benefits Team.
• Lead Pharmacy Benefits Team meetings when Supervisor is out of office.
• Send weekly emails regarding new claim rejections, system updates, procedures for overrides, plan changes, onboarding plans, etc.
• Manage helpdesk ticketing system – distribute tickets, review incoming tickets, break down tickets into more manageable pieces, etc.
• Track projects and additional duties the team is assigned to ensure proper phone coverage.
• Review phone calls to ensure KPIs are being met.
• Generate call stats for the team.
• Assist with Plan Note development.
• Assist with enrollments.
• Track and coordinate different projects in the pipeline.
• Assist team members to streamline their workflow.
• Address concerns with the Supervisor and help find solutions.
• Participate in calls when necessary - Answer telephone inquiries in a pleasant, professional and efficient manner assuring exceptional customer service.
• Document all incoming calls and dialogue in the claims adjudication software.
• Educate clients on plan policies, benefits and procedures.
• Resolve client drug benefit concerns of a medical, financial, or technological nature.
• Initiate and facilitate prior authorization requests.
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
• Participate in on-call rotation.
• Attend department and company meetings and educational programs upon request.
• Ensures that HIPAA guidelines are followed in every communication with clients.
• Identify team building activities.
• Accept other duties as assigned.

Qualifications:

• Associate’s degree preferred. High School Diploma or equivalent required.
• 3 years of customer service/call center and industry experience.
• 2-3 years of Healthcare industry experience, preferred. (Health plan or insurance experience, a plus. PBM experience preferred.)
• CPhT (Certified Pharmacy Technician) certification, required. Obtained within 1 year or employment date, or 6 months of promotion date.
• Experience in a pharmacy support role, preferred.
• Current on plan and benefit structures and Medicare guidelines.

Knowledge, Skills, Abilities:

• Demonstrated leadership skills

Ability to implement tactical operating policies and procedures for the work team.

• Ability to manage multiple work streams and keep them on course

Solid knowledge and awareness of TRHC products and services within the department. Demonstrated ability to provide consistent and solid service to clients and has developed expertise in products and services. Knowledge of pharmacology and pharmacological terms. Excellent communication skills and professionalism when working with clients. Ability to solve problems under pressure by making immediate decisions while on the phone. Detail oriented and able to prioritize workload. Strong computer skills including using word processors, spreadsheets, and database software.

Supervisory Responsibility: None

Travel: None

Expected Hours of Work:

This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.

Physical Demands & Requirements:

• Communicates by way of the telephone with providers, participants, customers, and vendors; majority of the work day is spent communicating on the telephone
• Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
• Remains stationary for extended periods of time
• Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
• Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
• Occasional reaching to retrieve shelved items
• Occasional bending/stooping

Work Environment:

• This job operates in a professional office environment with a conversational noise level.
• No substantial exposure to adverse environmental conditions is expected.
• Moderate pressure to meet scheduled appointments and deadlines

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.