Pharmacy Call Center Representative I


Exemption Status: Non-Exempt
Salary Grade: C03
Job Code: 7017

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to jobs.ou.edu and Search Postings to view positions that are currently accepting applications.

The following statements are designed to outline the general functions and typical responsibility levels associated with positions in this classification. They are not intended to serve as an exhaustive list of specific duties or requirements for individual positions assigned to this classification.
Essential Duties/Responsibilities:

Responsible for answering calls from Medicaid members, commercial members, and providers of both with a goal of achieving one call resolution. Provides support to patients, providers, and Pharmacy Staff by maintaining information, participating in surveys, resolving problems, cross training, and attending meetings.

  • Provides support to patients and providers. 
  • Responds to oral and written inquiries from the user community regarding Medicaid issues and related problems. 
  • Answers inquiries to include but not limited to Federal rules and regulations, Medicaid, managed care, and fee-for-service.  
  • Answers provider questions regarding medical claims. 
  • Provides support to the Pharmacy staff. 
  • Answers telephone calls, determines nature of call, and directs caller. 
  • May perform clerical duties.
  • Maintains information about providers. 
  • Stays abreast of constantly changing Medicaid fee-for-service and managed care rule revisions in order to provide accurate information. 
  • Organizes reference materials for easy access. 
  • Updates provider information.
  • Participates in patient related surveys.
  • Contacts Medicaid recipients for the completion of such surveys. 
  • Resolves problems according to agency rules and procedures.  
  • Provides guidance to Medicaid providers and commercial providers by identifying and correcting billing problems through the explanation of procedures and benefits.   
  • Cross trains with Pharmacy Support Staff and management to achieve competency in all areas of pharmacy support. 
  • Attends staff meetings and other meetings as needed. 
  • Performs various duties as needed to successfully fulfill the function of the position.



Minimum Requirements:

Education:

Required: High School Diploma or GED

Experience:

Required: None.

Certifications or Licenses:

  • None

Required Knowledge, Skills, Abilities:

  • Knowledge of Federal rules and regulations related to Medicaid, managed care, and fee-for-service
  • Ability to solve problems
  • Ability to train other Representatives
  • Customer service


Working Conditions:

Physical:
Sitting for prolonged periods. Speaking and listening. Constant use of the telephone.

Environmental:
Standard Office Environment.