AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs-wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.
Job Details
Under the supervision of the Manager of Client Relationship, the Client Relationship Specialist is responsible for acting as a first-line resource for external clients regarding Pharmastar's product lines, including (but not limited to) Medicare and Commercial prescription drug data, ensuring the necessary information is disseminated to the applicable resources within the organization. Candidate will demonstrate proficiency with resolutions of all common issues, questions and solutions.
This position also assists with various internal tasks that ensure a high level of overall client satisfaction. On the job training will be provided.
Pharmastar is a Pharmacy Benefits Manager (PBM) for commercial plans, Medicare Part D Plans and PACE Plans.
Responsibilities
- Serve as main contact for external clients requesting products (Medicare D and Commercial).
Requests include but are not limited to : formulary compliance, plan set-up, provider management, member enrollment / eligibility changes, patient concerns, reporting (scheduled and ad hoc), audit support, and claims assistance.
Perform client outreach and set up recurring calls.Serve as main contact for submission of internal workload requests to the Manager;Prepare, submit, and analyze PDE submissions to CMS;Research and suggest solutions for submission rejects;Assist in the reconciliation of PDE data;Summarize and report PDE progress;Support clients in all areas of Part D functions for compliance with regulatory requirements.Coordinate the submission of regulatory reporting to the appropriate management and governing agencies to ensure critical deadlines are met;Track all applicable regulatory updates and changes for incorporation into policies and procedures;Act as a first-line contact to external clients and assist in answering questions and / or triaging concerns to other associates.Build strong, trusting relationship with clients and its pharmacies.Present company product line services to clients as needed.Ensures that HIPAA guidelines are followed in every communication with clients.Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.Attend department and company meetings and educational programs upon request.Assist with answering Help Desk calls when needed.Perform administrative duties as required.Other projects as assigned.Qualifications
Bachelor's degree preferred. Associate's degree or formal training beyond high school, required.3-4 years of customer service and industry experience. (Health plan or insurance experience, a plus. PBM experience preferred.)CPhT (Certified Pharmacy Technician) certification, a plus.Experience in a pharmacy support role, a plus.Current on plan and benefit structures and Medicare Part D guidelines.Skills & Abilities
Demonstrated proficiency with resolution of all common issues, questions and solutions.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.Detail oriented and able to prioritize workload.Strong computer skills including using word processors, spreadsheets, and database software.Schedule
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
Communicates by way of the telephone, web (video conference), and email with clients;Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printerRemains stationary for extended periods of timeOccasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objectsVisual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and / or in hard copyAnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.
