Senior Pharmacy Resolution Specialist

Company	Centene
Location	Pennsylvania, USA, Delaware, USA, Washington, DC, USA, Texas, USA, Jackson Township, NJ, USA, Florida, USA, Waterbury, CT, USA, South Carolina, USA, Georgia, USA, Tennessee, USA, Virginia, USA, Colorado, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Ohio, USA, Louisiana, USA, Michigan, USA
Salary	$19.04 – $32.35
Type	Full-Time
Degrees
Experience Level	Senior

High School Diploma / GED
2 years of experience
Call center / customer service experience
Experience in healthcare environment (pharmacy operations, managed care, pharmacy hospitals and or pharmacy retail settings)

Act as a subject matter expert and handle more complex pharmacy issues
Respond to escalated calls from members, provider/physician’s offices, and pharmacies
Make outbound calls and enter pharmacy overrides into systems based on approved guidelines
Take member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests
Offer options including submission of a prior authorization request
Thoroughly research issues and take appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards
Answer and conduct inbound and outbound calls with members and provider offices to provide resolution to claims
Assist team members often guiding them to the appropriate resolution of more complex and difficult inquiries
Participate in the training of less experienced staff, including opportunity for job shadowing
Act as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility
Present proposed solutions in a clear and concise manner
Assist with audit preparation as needed
Assist with miscellaneous special project work as assigned
Perform other duties as assigned
Comply with all policies and standards