Pharmacy Resolution Specialist

Job Summary

A company is looking for a Pharmacy Resolution Specialist to 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 issues thoroughly and take appropriate actions to resolve inquiries while adhering to regulatory and corporate guidelines
• Maintain expert knowledge on pharmacy benefits and formularies, and assist with prior authorization and coverage determination processes

Required Qualifications

• High School Diploma or GED
• At least 1 year of experience in a call center or customer service role
• Knowledge of pharmacy and medical benefits
• Ability to interpret CMS regulations related to pharmacy benefits
• Experience in logging, tracking, and resolving inquiries and complaints