Description:
GENERAL SUMMARY
Acts as a liaison to the health plan to research and coordinate operational and communication issues with pharmacy benefits.
ESSENTIAL RESPONSIBILITIES
- Coordinates and facilitates problem resolution for pharmacy issues (i.e., prescription benefits).
- May serve as team lead and provide support to Pharmacy Account Representatives.
- Researches, analyzes, coordinates, and implements pharmacy approvals and denials. Communicates resolution to physicians, pharmacies, and members.
- Conducts system testing. Tracks and responds to all interface problems/issues.
- Transmits benefit information updates as needed including prior authorization, vacation overrides, quantity edits, and special approval for non-covered agents.
- Researches, coordinates, and enters information into vendor’s system for prior authorization, including contacting prescribing physician, vacation overrides, and supply edits. Coordinates documents with health plan’s Medical Director for approval or denial.
- Resolves pharmacy claims issues for network pharmacies not paid on-line.
- Supports pharmacy initiatives by providing physician/member communications.
- Responds to group, member, and physician eligibility issues on error reports.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience.
- Previous (1-2 years) customer service experience required.
- Previous Pharmacy Technician experience preferred.
- Computer knowledge including Microsoft Office and data entry required.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Downers Grove, IL, US
Other Locations: Harrisburg-Pennsylvania-United States,
Organization: 37200 - Coventry Product Services, Inc
Schedule: Full-time
Job Posting: 2013-07-09 00:00:00.0
Job ID: 1312251
GENERAL SUMMARY
Acts as a liaison to the health plan to research and coordinate operational and communication issues with pharmacy benefits.
ESSENTIAL RESPONSIBILITIES
- Coordinates and facilitates problem resolution for pharmacy issues (i.e., prescription benefits).
- May serve as team lead and provide support to Pharmacy Account Representatives.
- Researches, analyzes, coordinates, and implements pharmacy approvals and denials. Communicates resolution to physicians, pharmacies, and members.
- Conducts system testing. Tracks and responds to all interface problems/issues.
- Transmits benefit information updates as needed including prior authorization, vacation overrides, quantity edits, and special approval for non-covered agents.
- Researches, coordinates, and enters information into vendor’s system for prior authorization, including contacting prescribing physician, vacation overrides, and supply edits. Coordinates documents with health plan’s Medical Director for approval or denial.
- Resolves pharmacy claims issues for network pharmacies not paid on-line.
- Supports pharmacy initiatives by providing physician/member communications.
- Responds to group, member, and physician eligibility issues on error reports.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience.
- Previous (1-2 years) customer service experience required.
- Previous Pharmacy Technician experience preferred.
- Computer knowledge including Microsoft Office and data entry required.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Downers Grove, IL, US
Other Locations: Harrisburg-Pennsylvania-United States,
Organization: 37200 - Coventry Product Services, Inc
Schedule: Full-time
Job Posting: 2013-07-09 00:00:00.0
Job ID: 1312251