Pharmacy Resolution Specialist

Job Summary

A company is looking for a Pharmacy Resolution Specialist who will manage inquiries related to pharmacy benefits and prior authorization requests.

Key Responsibilities

• Receive and respond to calls from members, providers, and pharmacies regarding benefit questions and prior authorization requests
• Research and resolve issues, logging and tracking inquiries while adhering to regulatory and corporate guidelines
• Maintain expert knowledge of pharmacy benefits and assist with prior authorization and appeal processes

Required Qualifications

• High School Diploma or GED
• 1 year of job-specific call center or customer service experience
• Knowledge of pharmacy and medical benefits
• Ability to interpret CMS regulations related to pharmacy benefits
• Experience in managing inquiries and complaints in a timely manner