Pharmacy Resolution Specialist
| Company | Centene |
|---|---|
| Location | Florida, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Entry Level/New Grad |
Requirements
- High School Diploma / GED
- 1 year of Job Specific call center/customer service experience
Responsibilities
- 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 in which special care is required to enhance Centene relationships, while meeting and exceeding all performance standards
- 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 (i.e.: additional information requests and medication determination updates)
- 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.