Job Description:

Associate, Pharmacy Specialist 625 State St, Schenectady, NY 12305, USA Rochester, NY, USA Tarrytown, NY, USA Vermont, USA Req #1987 Thursday, April 18, 2024 Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP! Status: Non-Exempt This position will help licensed pharmacists take care of many of the daily operations of the pharmacy department. Individuals in this fast-paced, frequently changing regulatory position will be responsible for: calling providers, members, and pharmacies; having knowledge of pharmacy benefits (medical and retail-based) for MVP's multiple lines of business (Medicare/Commercial/Medicaid/etc.), multiple formularies and associated policies and staying on top of ongoing regulatory, formulary and policy changes; providing drug-related information to Customer Care Center and other internal departments; managing incoming faxes and incoming coverage requests from multiple sources requesting drug coverage; determining eligibility and evaluating pre-authorization requirements using multiple systems; obtaining additional information and initiating cases for review when appropriate for multiple lines of business (each with unique and changing regulatory requirements and timeframes ) ; preparing cases for review by Pharmacists; requesting additional clinical information for case completion from provider via verbal and fax requests; completing case files by creating appropriate member/provider written notifications, initiating the printing of these letters, and making outgoing approval and denial calls to provide members/providers with prior authorization request outcome d eterminations and fielding difficult conversations regarding denial decisions, within all regulatory timeframes, while handling with tact and sensitivity; creating and monitoring timeframe activity reports at least daily or more frequently as applicable and escalating cases with impending timeframes; ensures that regulatory timeframes are met using learned knowledge and daily tracking; creating and maintaining reports using MS Excel, Access, and other reporting tools; loading different types of authorizations and testing for accuracy; supporting the Medicare MTM program by utilizing communication skills such as motivational interviewing to gain agreement from members to participate in comprehensive medication reviews (CMR); perform special projects, and is cross-trained in selected functions, as assigned. Performs other duties as assigned. This position will be a virtual (remote) based position. It does require weekend work on a regular or rotating basis and holiday work as assigned. Daily hours range from 8:30 - 5:00 pm or 9:30 - 6:00 pm as assigned. Schedules are subject to change based on business need. POSITION QUALIFICATIONS Minimum Education: AAS degree preferred, or equivalent combination of education and experience required. Completion of Pharmacy Technician course preferred. Minimum Experience: 1-2 years of data entry experience 1-2 years of customer service experience resolving complex customer inquiries Related to required minimum experience above, relevant insurance, medical or healthcare experience involving prior authorizations and/or prescription medication services is highly preferred. Required Skills: Strong written and verbal communication skills using different tools (email, fax, phone, chat, etc.) Strong data entry skills with superior attention to detail Moderate to strong computer literacy with proficiency in MS Word, Excel, Teams, and Outlook Flexibility to adapt to changing environment and/or workflow processes on a day-to-day basis. Ability to excel in a fast-paced, deadline-oriented position using superb time management skills. Ability to work independently in a team environment with desire to help others. Maintains professional approach in workplace with strong interpersonal skills. Strong desire to learn, improve and adhere to complex processes as defined. Excellent customer service skills, ability to deal with stressful calls in a professional manner, and willingness to do so on a daily basis. Familiarity with healthcare benefits, pharmacy, and medical terminology. Previous experience requiring strict adherence to confidentiality. Ability to sit at workstation for long periods of time in front of computer. Ability to multi-task using multiple computer systems and prioritize work. About MVP MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors , including but not limited to geographic location ; relevant experience, education, and training; and the nature of and demand for the role. In addition, we offer a comprehensive benefits package that includes: Considerable paid time away from work including PTO (Paid Time Off), s ick t ime, service t ime o ff, p aid h olidays, and f loating h olidays , allowing you to take time off when it suits you best. Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement. Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family. Life insurance and disability coverage to ensure financial security for you and your dependents. An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected. Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning. A best-in-class employee Well-Being program to support all dimensions of your health and wellness. MVP Health Care analyzes the latest market data to determine employee compensation. Compensation figures listed in a job posting are subject to change as new market data becomes available. The salary range, other compensation, and benefits information is accurate as of the date of this posting. MVP Health Care reserves the right to modify this information at any time, subject to applicable law. More detailed information about total compensation and benefits will be provided during the hiring process. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@ Please apply and learn more - including how you may become a proud member of our team. Other details Job Family Pharmacy Pay Type Hourly Min Hiring Rate $20.00 Max Hiring Rate $27.60