Job Description Job Description
Put your pharmacy expertise to work beyond the counter in a role focused on claims resolution, prior authorizations, and medication access. Join a collaborative team where your knowledge directly improves the patient experience
LOCATION
Fresno, CA Onsite
COMPENSATION & SCHEDULE
• $22.00 - $23.00 per hour (Based on experience and certifications)
• Monday - Friday 8-hour shift scheduled between 6:00 AM - 7:00 PM PST Rotating weekend coverage required
• W2 Employment Temp to Hire
ROLE IMPACT
The Patient Service Rep supports medication access by resolving pharmacy claims, benefit verification, eligibility, and prior authorization inquiries. This role works with pharmacies, healthcare providers, and patients to resolve coverage issues accurately and efficiently while maintaining HIPAA and healthcare regulatory compliance. Success is measured by claims accuracy, documentation quality, customer service, productivity, and compliance.
KEY RESPONSIBILITIES
• Support inbound inquiries related to pharmacy claims, pharmacy benefits, eligibility, and prior authorizations.
• Research and resolve pharmacy claim rejections, third-party billing issues, coverage discrepancies, formulary requirements, and plan details.
• Accurately document customer interactions and case activity within internal systems.
• Support customers through phone, email, and chat while meeting quality and productivity expectations.
• Escalate clinical questions and complex issues to licensed pharmacists or appropriate support teams while maintaining HIPAA compliance.
LICENSES & CERTIFICATIONS
• Active Pharmacy Technician License
Certification through PTCB or NHA required within 6 months of conversion
• High School Diploma or GED.
• Minimum 2 years of pharmacy technician experience in retail pharmacy, hospital pharmacy, mail order pharmacy, specialty pharmacy, Pharmacy Benefit Management (PBM), or healthcare operations.
CLINICAL SKILL SET
• Pharmacy claims processing and claims resolution
• Benefit verification and eligibility
• Prior authorization support
• Pharmacy claims adjudication
• Third-party billing
• Formulary and pharmacy benefit coverage
• HIPAA-compliant documentation
PREFERRED SKILLS
• Experience with prior authorizations, pharmacy claims processing, PBM, managed care, specialty pharmacy, or healthcare call center operations.
• Familiarity with pharmacy claims adjudication systems and third-party billing.
• Strong attention to detail, documentation, customer service, communication, and ability to manage multiple priorities.
EQUIPMENT & WORK ENVIRONMENT
• Prolonged computer use with keyboard, mouse, headset, and multi-line phone system.
• Primarily sedentary position with occasional standing, walking, reaching, and bending.
• Fast-paced healthcare support environment with productivity, quality, and compliance expectations.
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