Job Description
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 The Customer Support Specialist is responsible for answering calls from our clients and providing timely and accurate responses in a professional and courteous manner. This position works with internal and external clients which include members, clinicians, pharmacies, plan sponsors and other departments within the company. Responsibilities Answer telephone inquiries in a pleasant, professional, and efficient manner assuring exceptional customer service. Document all incoming calls and dialogue in the claims adjudication software. Educate clients on plan policies, benefits, and procedures. Resolve client drug benefit concerns of a medical, financial, or technological nature. Initiate and facilitate prior authorization requests. Make outbound calls to pharmacies and plans to facilitate completion of JIRA tickets. Review after hours calls log-complete any follow up as needed. Submit JIRA tickets for compound prescriptions. Submit JIRA tickets to resolve NDC issues (pricing issues, missing NDCs) Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines. Accept other duties as assigned; including but not limited to direct member reimbursement, processing, manual claims, reporting, and researching rejected claims. Ensures that HIPAA guidelines are followed in every communication with
