Pharmacy Resolution Specialist
| Company | Centene |
|---|---|
| Location | Texas, USA, Florida, USA, Arizona, USA, Missouri, USA, Michigan, USA |
| Salary | $15.58 – $26.73 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Entry Level/New Grad, Junior |
Requirements
- High School Diploma / GED
- 1 year of Job Specific call center/customer service
Responsibilities
- Receives and responds to calls from members, provider/physician’s offices, and pharmacies
- Makes outbound calls and enters pharmacy overrides into systems based on approved guidelines
- Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests
- Offers options including submission of a prior authorization request
- Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards
- Logs, tracks, resolves, and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and Centene Corporate guidelines
- Maintains expert knowledge on all pharmacy benefits and formularies, including CMS regulations as they pertain to this position
- Responsible for knowing and interpreting pharmacy and medical benefits
- Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims
- Actively involved in the initiation and providing status for prior authorization/coverage determination, appeal/redetermination phone calls
- Responsible for ensuring outstanding attention to detail
- Identify root cause issues to ensure enterprise solutions and communicate findings as needed to ensure first call resolution
- Assists with special projects as assigned
- Performs other duties as assigned
- Complies with all policies and standards
Preferred Qualifications
-
No preferred qualifications provided.