LOCATION: W. Idlewild Avenue, Tampa, FL 33634
DEPARTMENT: Operations – Pharmacy 2.0
REPORTING TO: Supervisor, Operations
The Pharmacy Resolution Specialist responds to escalated issues from both provider/physician's offices and pharmacies received through transferred phone calls and customer service management and resolves those issues. Enters pharmacy overrides into the PBS/RXClaims system based on approved guidelines and approvals from Clinical Pharmacists. Makes out bound calls to physicians and pharmacies. Responsibilities also include miscellaneous special project work.
Additional Responsibilities:Candidate Education:
- Log, track, resolve and respond to all assigned inquiries and complaints while meeting all regulatory, CMS, and WellCare Corporate guidelines in which special care is required to enhance WellCare relationships; while meeting and exceeding all performance standards.
- Enters DER overrides into the PBS/RXClaims system on a timely basis.
- Identify root cause for pharmacy claims issues and assist pharmacies in getting claims processed, so member can receive their medication.
- Follows pharmacy guidelines to make decisions on drug overrides for vacations, refill too soon and emergency request.
- Accurately take verbal DER and appeals request.
- Ability to follow directions.
- Assists with special projects as assigned or directed.
- Required A High School or GED
- Preferred An Associate's Degree in a related field
- Required 1 year of experience in In a call center or customer service environment.
- Preferred 1 year of experience in Experience in healthcare environment (pharmacy operations, managed care, hospitals and/or retail environments).
Licenses and Certifications:Technical Skills:
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Beginner Other Ability to use pharmaceutical references.
- Beginner Other Ability to evaluate information from both oral and written sources, pharmaceutical references and report information to pharmacists.
- Beginner Other Working knowledge of prescription medications and pharmacotherapy.
- Intermediate Other Ability to follow direction.
- Required Intermediate Microsoft Word Knowledge of Microsoft Office including Word, Excel and Power Point
- Required Intermediate Microsoft Excel Capable of learning to use Sidewinder, Crystal and WHI Data bases
- Required Intermediate Microsoft Outlook
- Required Beginner Healthcare Management Systems (Generic)