Senior Pharmacy Resolution Specialist
| Company | Centene |
|---|---|
| Location | Texas, USA, Florida, USA, North Carolina, USA, Missouri, USA, Michigan, USA, Illinois, USA |
| Salary | $19.04 – $32.35 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Senior |
Requirements
- High School Diploma / GED
- 2 years of experience in Call center / customer service
- Experience in healthcare environment (pharmacy operations, managed care, pharmacy hospitals and or pharmacy retail settings)
Responsibilities
- 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
Preferred Qualifications
- Pharmacy technician certification preferred