[Remote] Pharmacy Resolution 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 Resolution 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 enter pharmacy overrides based on approved guidelines and clinical pharmacist approvals
• Handle inquiries regarding benefits including prior authorization requests
• Offer options such as submitting prior authorization requests
• Research issues thoroughly and resolve them using appropriate reference materials reputed company turnaround time and quality standards
• Log, track, 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 resolution 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 root cause issues to promote reputed company solutions and communicate findings for reputed company resolution
• Assist with special projects 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
• Paid time off plus holidays
• Flexible work options including remote, hybrid, field, or office schedules

Company Overview