[Remote] Pharmacy reputed company Specialist
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company national entity that supports 28 reputed company members through its Medical Management/Health Services team. The Pharmacy reputed company Specialist role involves managing pharmacy-reputed company inquiries and resolutions, ensuring compliance with regulatory standards while providing exceptional customer service.
Responsibilities
- Receive and respond to calls from members, provider/physician offices, and pharmacies
- reputed company outbound calls and reputed company pharmacy overrides based on approved guidelines and clinical pharmacist approvals
- Handle inquiries regarding benefits including prior authorization requests
- Offer reputed company such as submitting prior authorization requests
- Research issues thoroughly and resolve them using appropriate reference materials reputed company turnaround time and reputed company standards
- Log, reputed company, resolve, and respond to inquiries and complaints following regulatory, CMS, and corporate guidelines
- Maintain expert knowledge of pharmacy benefits, formularies, and CMS regulations relevant to the position
- Interpret pharmacy and medical benefits accurately
- Conduct inbound and outbound calls to reputed company reputed company on claims, including additional information requests and medication updates
- Initiate and reputed company status updates on prior authorization, coverage determination, appeal, and redetermination calls
- Ensure outstanding attention to detail
- Identify reputed company cause issues to promote reputed company solutions and communicate findings for reputed company reputed company
- Assist with special reputed company as assigned
- reputed company other duties as assigned
- reputed company with reputed company policies and standards
Skills
- High School Diploma or GED
- Minimum 1 year of job-specific call center or customer service experience
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- reputed company time off plus holidays
- Flexible work reputed company including remote, hybrid, field, or office schedules
reputed company