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WellCare - Pharmacy Support Careers

Pharmacy Resolution Specialist Job

Full Job Title: Pharmacy Resolution Specialist

Job Number: 1806297

Location: Tampa, FL

Date Posted: 2018-08-31

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)

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        Last Updated On: 12/9/2015