Senior Pharmacy Resolution Specialist

Centene Corporation•Remote-FL, FL

1d•$19 - $33•Hybrid

About The Position

The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handles more complex pharmacy issues and respond to escalated calls from members, provider/physician's offices and pharmacies. This role will make outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists. 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 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) Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards Assists team members often guiding them to the appropriate resolution of more complex and difficult inquiries Participates in the training of less experienced staff, including opportunity for job shadowing Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility Presents proposed solutions in a clear and concise manner Assists with audit preparation as needed Assists with miscellaneous special project work as assigned Performs other duties as assigned Complies with all policies and standards

Requirements

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).
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Nice To Haves

Pharmacy technician certification preferred.

Responsibilities

Act as a subject matter expert and handles more complex pharmacy issues and respond to escalated calls from members, provider/physician's offices and pharmacies.
Make outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists.
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 (i.e.: additional information requests and medication determination updates).
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.