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Pharmacy
WellCare - Pharmacy Support Careers

Pharmacy Resolution Specialist Job

Full Job Title: Pharmacy Resolution Specialist

Job Number: 1705052

Location: Tampa, FL

Date Posted: 10-31-2017

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.

Essential Functions:

  • 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.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
  • Preferred An Associate's Degree in a related field
Candidate Experience:
  • 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).
Candidate 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.
Licenses and Certifications:Technical Skills:
  • 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)
Languages:

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Last Updated On: 12/9/2015