Intermountain Healthcare Pharmacy Benefits Specialist/Customer Service - SelectHealth in Salt Lake City, Utah

Job ID:213353
Greater Salt Lake area

About Us

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

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

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

Interested in joining the SelectHealth team? Watch this brief video to find out why SelectHealth has been consistently named one of Utah's top places to work!

SelectHealth was named one of Utah’s “Best Companies to Work For” for six out of the last seven years by Utah Business magazine. It was also named one of the “Top Places to Work In the Wasatch Front” by the Salt Lake Tribune. Here are some of the reasons we continue to be one of the best companies to work for:

  • State-of-the-art fitness center
  • Full service cafeteria
  • Free/covered parking
  • Central location
  • Employee appreciation events/ Employee Advisory Council
  • Onsite ATM
  • Health and wellness programs
  • Beautiful LEED Certified building
  • Education and development opportunities
  • LiVe Well Incentive Program

Job Description

The Pharmacy Benefit Specialist is responsible for expeditious and accurate adjudication of pharmacy claims and the provision of excellent customer service to all members, employer groups, providers and other departments or teams. In this position the Pharmacy Benefit Specialist has the opportunity to rotate between pharmacy claims and customer service responsibilities. This vital position is valued for their superior customer service skills including problem solving, telephone etiquette, and responsiveness to customers.

Candidate may be hired as a Pharmacy Benefits Specialist I or II depending on experience.

Essential Job Duties

  • Processes and/or communicates multiple types of pharmacy benefits including coordination of benefits, direct member reimbursements, coinsurance benefits and mail order prescriptions.
  • Receives incoming calls from members, providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values and quality standards.
  • Educates callers on correct use of their plans, including coverage of benefits, utilization, and administrative guidelines, in collaboration with teammates and other departments. Makes exception/empowerment decisions within the established exception policy.
  • Consistently demonstrates excellent customer service skills including problem solving, telephone etiquette, and responsiveness to customers.
  • Ensures that all department standards and expectations are met pertaining to call statistics, production, documentation, and quality/accuracy.
  • Efficiently and quickly addresses and solves problems on phone calls.
  • Meet s or exceeds department standards for call time and answered call percentage in relation to the team average.
  • Efficiently and accurately enters overrides for pharmacy claims. Meets or exceeds department standards for override audits.
  • Meets or exceeds aux code standards for the department.
  • When assigned, assists in the payment of claims for both members and pharmacies while maintaining accuracy standards.
  • Completes and analyzes specialized reports that are used to ensure timely and accurate claims adjudication.
  • Works closely with the operation and pharmacy teams to educate the staff and resolve problems.
  • Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy.
  • Maintains customer history in member tracking using correct codes and detailed comments.

Posting Specifics

  • Entry Rate: $14.71/hour or more, depending on experience.
  • Benefits Eligible: Yes
  • Shift Details: Full-time, 40 hours/week. Once trained, working hours would be within 7:00 AM to 8:00 PM Monday through Friday. The department also requires one closing shift per week (11:30 am - 8:00 pm) and a rotating Saturday per month (9:00 am - 3:00 pm).
  • Department : Pharmacy Operations - SelectHealth
  • Additional Details: We have six openings for this training class. The anticipated start date will be mid-May to early June 2018. Training hours will be 8:30 AM - 5:00 PM for the first four to six weeks of employment.

Minimum Requirements

Pharmacy Benefits Specialist I

  • One year combined experience in any of the following: medical/pharmacy claims processing; health benefit coordination; customer service experience; pharmacy technician experience.
  • Experience utilizing word processing software.

Pharmacy Benefits Specialist II

  • Nine months as a Pharmacy Benefits Specialist I and meeting minimum performance and transition standards outlined in Pharmacy Services Guidelines or current national pharmacy technician certification.
  • Demonstrated capability of processing or communicating the following types of pharmacy benefits: coordination of benefits, direct member reimbursements, coinsurance benefits, and mail order prescriptions.

Physical Requirements

  • Manual dexterity, hearing, seeing, speaking.

Preferred Requirements

  • Pharmacy technician education, training, or work experience
  • Health plan experience
  • Problem solving capabilities, analytical skills, self-motivated, and able to work well under pressure and through frequent interruptions.
  • Demonstrated excellent verbal and written communication skills individually and within groups.
  • Experience with Facets/AWD system
  • Health care customer service and claims processing experience.

Please Note

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

Additional Details:

Working Hours 40

Primary Work Location SelectHealth

Expertise Clerical / Secretarial / Business Office Support, Pharmacy

Job Type Full Time

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