Submission for the position: Pharmacy Resolution Specialist - (Job Number: 1324941)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1324941&lang=en
Pharmacy Resolution Specialist
* Applicants for this job have the flexibility to work remote from home and must reside in MI, CA, FL*
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
• 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
• Shift: 1:00pm-9:30pm EST
Our Comprehensive Benefits Package:
• Flexible work solutions including remote options, hybrid work schedules and dress flexibility
• Competitive pay
• Paid Time Off including paid holidays
• Health insurance coverage for you and dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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