Pharmacy Benefits Advocate

About Us
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications provide solutions for a range of payers, providers, and other healthcare organizations. We’re on a mission to enable simplified and individualized care that improves the health of those we serve.
We’re looking for people who are excited to drive this transformation. To break barriers and think of new ways to adapt, help, and create better experiences for patients—and for each other. This is where diverse backgrounds, beliefs, and perspectives matter and where “care” is centric to who we are. Come do more than join something, change something. For patients, for their families, for the future of healthcare.
DATE: 03/2024
JOB TITLE:Pharmacy Benefits Advocate (PBA)
REPORTS TO: Leadership as assigned.
DEPARTMENT(S): Value Based Care Solutions – PBM
FLSA: Non-exempt
JOB OBJECTIVE: The Pharmacy Benefits Advocate 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.
ESSENTIAL JOB FUNCTIONS:

• 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 clients.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job.
QUALIFICATION REQUIREMENTS: These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION:

• Required:
• Associate’s degree or equivalent combination of education or work experience.
• Preferred:
• CPhT (Certified Pharmacy Technician) Certification.

EXPERIENCE:

• Required:
• A minimum of 3 years of experience in customer service/member service in a call center or similar.
• A minimum of 2 years of experience in the healthcare industry.
• A minimum of 2 years of experience in a pharmacy support role.
• Knowledge of plan and benefit structures and Medicare guidelines.

OTHER SKILLS and ABILITIES:

• Knowledge of pharmacology and pharmacological terms.
• Excellent communication skills and professionalism when working with clients.
• Ability to solve problems under pressure by making immediate decisions while on the phone.
• Detail oriented and able to prioritize workload.
• Strong computer skills including using word processors, spreadsheets, and database software.

PHYSICAL/MENTAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. Uses computer hardware, and other basic office equipment, which may require long periods of typing on a keyboard and reading on a monitor. Must be able to multi-task under deadlines, and handle periods of high degree of stress. May encounter long periods of routine work.
Expected Hours of Work: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
Travel: None
Supervisory: None
The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.