Service Specialist jobs at HCA Healthcare - 41 jobs

Responsible for answering inbound customer service calls related to patient accounting questions. When inbound call volumes are low incumbent may make outbound follow up calls on outstanding AR accounts. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Answer inbound customer service calls and make some outbound follow up calls in a professional, service-oriented manner. Answer the calls timely without drops/abandons. * Ascertain the reason for the call and assist the caller with their questions, concerns or problems with the focus on first call resolution. Facilitate resolution by referring the matter to the issue/content expert. Escalate the matter to a supervisor, request the appropriate information or take appropriate action so that the issue expert is able to effectively resolve the matter. * Other duties as assigned. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Exceptional customer service skills including effective and efficient problem solving and analyzing skills * Professional and calming tone of voice with complete command of the English language free of use of inappropriate grammar * Ability to facilitate conversations with others and establish an understanding of the customer's issue/reason for contact * Ability to perform essential job functions with high degree of independence, flexibility, and creative problem-solving techniques * Ability to maintain control of the call by de-escalating issues and instilling confidence that the resolution has been found. * Ability to function effectively under stress of conflicting demands on time and attention and, sometimes, under duress from difficult personalities * Ability to interpret and apply reimbursement aspects of managed healthcare contracts * Attentive listening skills * Ability to clearly articulate a response to the customer using appropriate voice modulation Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High school education or the equivalent * 1 - 2 years prior experience in an inbound call center and/or customer service environment; hospital patient account billing with experience or knowledge of 3rd party reimbursements from insurance companies and government payers is a plus. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Call Center environment with headset and multiple workstations within close proximity * Hospital Environment may include direct patient interaction As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Provide prospective and existing members with assistance (telephonically inbound and outbound) completing state required applications, for the purpose of obtaining and maintaining healthcare coverage, and accurate information for eligibility for Medicaid, CHP and Essential Plan. Provide non-clinical reminders (i.e.; product overviews, premiums, gaps in care, care management, member engagement events etc..) and assist as needed with resolving issues, scheduling appointments, conducting outreach to appropriate State entities and resources to ensure member satisfaction, retention initiatives and quality metrics are met. Job Duties • Pro-actively facilitate outreach (and handle inbound calls) to Molina members regarding their upcoming recertification with the state and healthplan. Educating members on process, qualifications, necessary documentation needed etc; while completeing the required applications and submissions to the State. • Management of individual State dashboards required • Assist and resolve complex member issues related to application errors, immigration status, multi-family enrollment, premiums, eligibility; etc. • Provide non-clinical reminders (i.e. product overviews, premiums, gaps in care, member engagement events etc.) • Facilitate the closure of at-risk care gaps, scheduling appointments, conducting outreach to appropriate State entities, direct toward available resources and care management opportunities; to ensure member satisfaction, retention, and drive plan quality performance. • Responsible for promoting and increasing member enrollments into plan programs (i.e.; Member portal, Rewards Program, etc.) • Assists Medicaid Members in contacting their social worker regarding eligibility issues and follow-up with members to ensure follow through, if allowed by the member's respective state. • Conduct outreach to retain members that have been identified as late renewals, post terms and potential disenrollments, assist and educate members on next steps and required paperwork. • Accurately and timely documentation of outreach in the appropriate databases. • Collaborate with the leadership team to provide feedback, trends and insights for areas of opportunity for improvement related to technology, process, people, retention and member experience. • Access a number of organizational based platforms and tools for the purpose of inputting and outputting data, related to documenting member care, status, renewal status etc. (such as: Salesforce, CCA, Sharepoint, Excel, Genesys etc) • Attend and assist with in-person community based member retention events • Placement in demonstrated high foot traffic locations, to assist with member in-person interactions may be required. Assist with in-person renewals, eligibility issues, application updates, submission of paperwork etc.. • Maintain appropriate certifications and quality scores in compliance with the State and Molina Healthcare. • Some in office trainings, meetings and field work required; will be based on business needs • Other tasks or special projects as required or directed Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalent REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • 2-4 years customer service experience, preferably in a call center environment • Experience communicating with members in a customer service setting and have the ability to assess needs and make thoughtful decisions to help a member REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: Must have NYS Certified Application Counselor Certification and/or be able to obtain certification within 60 days of hire date PREFERRED EDUCATION: Associate's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 3-5 years customer service experience in a call center environment To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The purpose of the Customer Service Representative position is to support the Customer Service Call Center as it relates to physician billing for multiple clients. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Handle a large call volume while ensuring quality customer service and patient satisfaction * issues not resolved during conversation with patient/guarantor * Ability to complete other related customer service duties as assigned SUPERVISORY RESPONSIBILITIES If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position serves as the primary source of communication for patients' billing inquiries. This person must possess the skill to effectively assist patients with sensitive and confidential issues, while understanding our obligation to our clients to collect outstanding patient balances. They should be able to handle multiple tasks along with setting appropriate priorities with client information. * Answer patient calls within the guidelines of call center metric objectives * Ensure appropriate HIPAA compliance guidelines * Adhere to work schedule and follow call center phone procedures * Maintain professionalism and confidentiality Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High School degree or equivalent required * At least 1 year experience in a medical customer service role preferred * Previous experience in a call center environment preferred * Proficiency in Microsoft Outlook, Excel and Word required * Previous experience with medical billing systems required; GE Centricity or EPIC experience a plus REQUIRED CERTIFICATIONS/LICENSURE Include minimum certification required to perform the job. N/A PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in sitting position, use computer and answer telephone * Ability to travel * Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment * Hospital Work Environment TRAVEL * No travel required Compensation and Benefit Information Compensation * Pay: $14.50 - $21.80 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The purpose of the Customer Service Representative position is to support the Customer Service Call Center as it relates to physician billing for multiple clients. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Handle a large call volume while ensuring quality customer service and patient satisfaction * issues not resolved during conversation with patient/guarantor * Ability to complete other related customer service duties as assigned SUPERVISORY RESPONSIBILITIES If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position serves as the primary source of communication for patients' billing inquiries. This person must possess the skill to effectively assist patients with sensitive and confidential issues, while understanding our obligation to our clients to collect outstanding patient balances. They should be able to handle multiple tasks along with setting appropriate priorities with client information. * Answer patient calls within the guidelines of call center metric objectives * Ensure appropriate HIPAA compliance guidelines * Adhere to work schedule and follow call center phone procedures * Maintain professionalism and confidentiality Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High School degree or equivalent required * At least 1 year experience in a medical customer service role preferred * Previous experience in a call center environment preferred * Proficiency in Microsoft Outlook, Excel and Word required * Previous experience with medical billing systems required; GE Centricity or EPIC experience a plus REQUIRED CERTIFICATIONS/LICENSURE Include minimum certification required to perform the job. N/A PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in sitting position, use computer and answer telephone * Ability to travel * Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment * Hospital Work Environment TRAVEL * No travel required Compensation and Benefit Information Compensation * Pay: $14.50 - $21.80 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Cash Posting Representative will be responsible for posting non-automated payments in the patient accounting systems for Conifer Clients to ensure bank deposits are posted on a daily basis. The primary goal is to ensure maximum revenue & service for our clients. This function is responsible for accurate and timely application of payments to patient accounts as well as researching and posting unidentified transactions. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Post payments electronically or manually in the patient accounting system * Research and resolve Unidentified Accounts using established Identification function/process. Ability to interpret remit language and understand payer behavior, forwarding balances/ overpayment recoveries. * Reconciles bank and special accounts, which may include: research, payment transfer or payment refund. Run queries to pull account details and monitor postings / transfers as applicable * Review/Research all payment related issues via email or work desk * Post payment corrections, payment transfers, inter-facility transfers, capitation payments, payroll deductions. Communicate with Reconciliation reps as required. * Call insurance companies for required remittance advice and/or missing information to post payments. Open tickets with business partners as deemed necessary using established Identification function/process for timely resolution of worked accounts * Identify and reconcile owner to owner refunds; track and log refund transactions between owners * Work Special Projects to completion KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Intermediate in Microsoft Office tools; knowledge of patient accounting systems a plus * Data entry and 10-key by touch * Critical thinking and analytical skills * Must be able to work concurrently on a variety of projects and work in a fast paced environment with a sense of urgency * Adaptable to Change and work in an evolving healthcare setting * Ability to communicate effectively, work independently as well as in a team Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High school diploma or equivalent * 2-3 years of related experience; payment posting/ hospital patient accounting systems a plus PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in sitting position, use computer and answer telephone * Ability to travel * Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment * Hospital Work Environment * Virtual Work Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Responsible for performing the payment application functions within the Reimbursement and Cash Management team. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Performs manual and electronic posting functions for all Managed Care, Commercial and Government payors for all patient accounts, including cash balancing and reconciliation of bank deposits. * Maintains knowledge of insurance rejection/denial processing and appropriately posts information for collection and follow-up activity. * Post payment corrections, payment transfers, NSF's, inter-facility transfers, * Payroll deductions and any other cash transactions for A/R accounts according to * established guidelines. * Research and clear Unapplied Accounts (bank, MCare, MCaid) using established Identification function/process. * Reconciles bank and special accounts which may include: research, payment transfer or payment refund. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Computer skills: MS Word, Excel, and Outlook; knowledge of patient accounting systems a plus * Good interpersonal skills * Strong customer service attitude and ability to work independently as well as in a team * Well organized and attentive to detail * Good math, analytical and problem-solving skills * Data entry and 10-key by touch Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High school diploma or equivalent * 2-3 years of related experience; payment posting a plus PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in sitting position, use computer and answer telephone * Ability to travel * Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment * Hospital Work Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * Ability to multi-task applications while speaking with members. * Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. * Ability to meet established deadlines. * Ability to function independently and manage multiple projects. * Excellent verbal and written communication skills, including excellent phone etiquette. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina's Quality Improvement Overread conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills. **Job Duties** + Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project. + Participates in scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's degree or equivalent experience **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E/KNOWLEDGE, SKILLS & ABILITIES:** - 3 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction **PR** **E** **FE** **R** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + At least 3 years of medical record abstraction experience + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA **PR** **E** **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina's Quality Improvement Overread conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills. **Job Duties** + Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project. + Participates in scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's degree or equivalent experience **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E/KNOWLEDGE, SKILLS & ABILITIES:** - 3 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction **PR** **E** **FE** **R** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + At least 3 years of medical record abstraction experience + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA **PR** **E** **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * Ability to multi-task applications while speaking with members. * Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. * Ability to meet established deadlines. * Ability to function independently and manage multiple projects. * Excellent verbal and written communication skills, including excellent phone etiquette. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Shift Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - Ability to multi-task applications while speaking with members. - Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. - Ability to meet established deadlines. - Ability to function independently and manage multiple projects. - Excellent verbal and written communication skills, including excellent phone etiquette. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * Ability to multi-task applications while speaking with members. * Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. * Ability to meet established deadlines. * Ability to function independently and manage multiple projects. * Excellent verbal and written communication skills, including excellent phone etiquette. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * Ability to multi-task applications while speaking with members. * Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. * Ability to meet established deadlines. * Ability to function independently and manage multiple projects. * Excellent verbal and written communication skills, including excellent phone etiquette. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Shift Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - Ability to multi-task applications while speaking with members. - Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. - Ability to meet established deadlines. - Ability to function independently and manage multiple projects. - Excellent verbal and written communication skills, including excellent phone etiquette. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * Ability to multi-task applications while speaking with members. * Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. * Ability to meet established deadlines. * Ability to function independently and manage multiple projects. * Excellent verbal and written communication skills, including excellent phone etiquette. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Shift Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - Ability to multi-task applications while speaking with members. - Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. - Ability to meet established deadlines. - Ability to function independently and manage multiple projects. - Excellent verbal and written communication skills, including excellent phone etiquette. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * Ability to multi-task applications while speaking with members. * Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. * Ability to meet established deadlines. * Ability to function independently and manage multiple projects. * Excellent verbal and written communication skills, including excellent phone etiquette. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $16.63 - $24.02 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Essential Job Duties** - Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. - Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. - Ensures that adequate staffing coverage is present at all times of operation. - Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. - Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. - Participates, researches, and validates materials for both internal and external program audits. - Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. - Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. - Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. - Participates in the daily workload of the department, performing Representative duties as needed. - Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. - Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. - Communicates effectively with practitioners and pharmacists. - Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. - Assists with development of and maintenance of pharmacy policies and procedures - Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. **Required Qualifications** - At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. - Knowledge of prescription drug products, dosage forms and usage. - Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. - Working knowledge of medical/pharmacy terminology - Excellent verbal and written communication skills. - Microsoft Office suite, and applicable software program(s) proficiency. **Preferred Qualifications** - Supervisory/leadership experience. - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Call center experience. - Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $55,706.51 - $80,464.96 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Essential Job Duties** - Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. - Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. - Ensures that adequate staffing coverage is present at all times of operation. - Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. - Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. - Participates, researches, and validates materials for both internal and external program audits. - Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. - Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. - Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. - Participates in the daily workload of the department, performing Representative duties as needed. - Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. - Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. - Communicates effectively with practitioners and pharmacists. - Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. - Assists with development of and maintenance of pharmacy policies and procedures - Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. **Required Qualifications** - At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. - Knowledge of prescription drug products, dosage forms and usage. - Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. - Working knowledge of medical/pharmacy terminology - Excellent verbal and written communication skills. - Microsoft Office suite, and applicable software program(s) proficiency. **Preferred Qualifications** - Supervisory/leadership experience. - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Call center experience. - Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $55,706.51 - $80,464.96 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.