Pharmacy Specialist, Team Lead

Description

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone.

The RX Team Lead is primarily responsible for assisting with managing the daily performance of RX Specialists within the Claims team. As a certified pharmacy technician, the RX Team Lead will be comfortable and familiar with prescription terminology and RX prior authorization practices, as well as requiring exceptional communication skills and the ability to adapt correspondence to a wide variety of audiences, including attorneys, claimants/injured workers, and medical professionals (providers and pharmacies alike). This position also requires ongoing coaching, making recommendations to standard operating procedures, de-escalating member issues, and ensuring team goals are met. Being comfortable with managing a workload or queue independently and assisting other team members with complex cases is a must.

The ability to work various shifts M-F between 8am-8pm EST is required.

Key Responsibilities:

• In concert with the RX Manager, provides guidance, support, and coaching to RX call center agents by ensuring adherence to work schedules to meet business needs and quality metrics
• Oversee the day-to-day work of the team by ensuring cases, tasks, and emails are handled in a timely manner
• Assist with all facets of people management including:

• New hire onboarding and training
• Identifying performance issues and providing coaching, feedback, motivation
• Administrative duties such as quality assessments, metric tracking utilizing BI and Dynamics reporting
• Measure team productivity and workload distribution to align with established department and company goals
• Track success metrics, report to management, and seek opportunities to make enhancements. 
• Monitor new hire performance to track against 90-day, 6 month goals

• Responsible for answering inbound calls and assisting members or pharmacies with RX claims
• Monitor and resolve all pharmacy rejected claims within the established turnaround times and in compliance with Medicare and regulatory requirements
• Follow-up on authorization requests in a timely fashion
• Contact members to obtain necessary approval on rejected pharmacy claims
• Contact pharmacy as needed to resolve any RX claim issues
• Contact PBM as needed to resolve any complex pharmacy issues
• Handle escalated member issues and resolve them effectively
• Collaborate with management and quality assurance team to implement processes, strategies, and training initiatives
• Document all communication, upload appropriate documents to internal database, and document clear concise notes in our database to ensure accounts are up to date
• Act in compliance with security and HIPAA policies and procedures
• Create and/or update SOPs or process documents as needed
• Join high level meetings and/or participate in special projects with Manager
• Contacting members to obtain any required pharmacy related information as needed
• Other duties as assigned

Required skills/experience qualifications for the role:

• State Licensed Pharmacy Technician in 1 or more states
• National Certification from an accredited pharmacy technician certification program
• 5+ years’ experience in a call center setting and experience in 2 or more pharmacy settings (Retail, Specialty, Prior Authorization/PBM, Medicare (Part D), etc.)
• 2+ years’ experience in training pharmacy technicians and comfortable with creating/updating SOPs or process documents. Previous experience as a Lead Pharmacy technician preferred.  
• Experience with phone and computer systems required, including some Microsoft applications which may include Outlook, Dynamics, Teams, Word, Excel, PowerPoint or Access.
• Proficient with prescription terminology and authorization practices
• Knowledge of healthcare information systems, Rx products and pharmacy services
• Excellent customer service skills
• Strong analytical and problem-solving skills
• Thorough understanding and proficient use of customer service best practices and techniques in the Pharmacy Benefit industry
• Strong conflict management and customer service skills
• Strong attention to detail.
• Ability to foster a positive and productive work environment

The estimated salary range for this position is $60,000USD to $70,000USD. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation.

#LI-BB1

In addition to our benefits package, employees have the opportunity to get involved with engagement, diversity, and philanthropic initiatives from their first day working with us to help us achieve our goal of Limitless Inclusion for All. As Ametros Citizens, we work together to foster an environment of limitless inclusion and belonging that encourages, supports, and celebrates the diverse voices and backgrounds of our people, while energizing the passion and innovations to revolutionize our industry.

Ametros is an Equal Opportunity Employer