Department

Job Title

Capital Rx is redefining the way prescriptions are priced and administered in the U.S. Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes. The company's commitment to innovation, technology, and service is why Capital Rx is the fastest-growing pharmacy benefit manager in America.

Customer Operations

Customer Care Pharmacy Technician (Full-Time) - New Mexico and Hawaii

We have an exciting full-time opportunity at Capital Rx, for remote candidates in the state of New Mexico and Hawaii (we are also accepting remote applications across the continental United States).

Location: Remote

Shifts: Candidates must be open to working any shift.

Position Responsibilities:

• Serve as first point of contact for incoming, prior authorization inquiries and appropriately escalates cases and all intake notes to the Clinical Prior Authorization Team
• Actively intake a thorough and complete prior authorization request from prescribers and members by asking applicable drug and client specific clinical questions
• Accurately advise callers on options for exception requests (formulary, copay, early refill, etc.) based on client benefit elections and provide additional information and status updates to prescribers, members, and pharmacies
• Efficiently triage incoming phone calls with professional phone etiquette from members, prescribers and pharmacies with minimal support. Ask probing questions to identify and resolve all issues and address concerns promptly
• Serve as a point of escalation for Customer Service Representatives handling member and pharmacy calls and serve as a backup based on availability and volume as necessary Identify, accurately document, and escalate member and pharmacy concerns to the appropriate internal team including various members of the Operations Team Effectively communicate issues and solutions to members, pharmacies, and relevant internal stakeholders to ensure customers receive quality care and that the resolution meets all health and safety standards.
• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast-paced, environment
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
• Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information and communicating findings to appropriate internal staff
• Work with multiple systems, up to 2 monitors, and multitask in a fast-paced environment
• Self-starter who displays a positive attitude, strong work ethic, and excellent attendance
• Meet all departmental goals including schedule adherence, attendance, and quality monitoring
• Standard hours for training: Monday thru Friday, 9:00am – 5:30pm, Eastern
• Perform other customer support duties as assigned
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications:

• High school diploma or the equivalent; Associates or Bachelors degree preferred
• National Certified Pharmacy Technician (CPhT) and license required
• 2+ years of pharmacy technician experience in a clinical pharmacy setting PBM, Health Plan, or related Health Care experience required
• 2+ years of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication
• Experience handling prior authorization requests/understanding of prior authorization requirements preferred
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, fast-paced, metric driven call center environment
• Bilingual Spanish highly preferred
• Medicare experience preferred

Hourly Rate: $28.00

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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