at Centene Corporation in Springfield, Illinois, United States
Job Description
You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: The Pharmacy Technician may perform duties in Pharmacy Technician (Appeals). Using established company guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits. The technician researches and resolves questions, problems or issues. May consult with Clinical Pharmacists or Regional Medical Director on related issues.
Pharmacy Technician – Appeals
Identifies validity of appeal. If not a valid appeal, be able to send request to correct department.
Verifies drug, dosage, quantity, provider, diagnosis information.
Research using formularies and prior authorization criteria to verify if additional information is needed. If additional information is needed, reach out to providers and members and communicating clearly what information is needed.
Other appeal tasks as assigned.
Education/Experience: High School diploma or GED required. 1 year Pharmacy Technician experience. Prior Authorization and Appeals, Grievances, Billing or claims, preferred.
License/Certification: Valid Pharmacy Technician License preferred.
Training: 8am-4:30pm or 10am – 6:30pm for the first 2 weeks, and then 10:00 -6:30am thereafter. Training time may change based on trainer availability during the first 2-4 weeks.
Shift after training: 10am-6:30pm Monday – Friday (In your own time zone). You could be asked to work a weekend day pending needs of the team. It is flexible on the day off during the week.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
TITLE: Pharmacy Technician (Appeals) – Remote
LOCATION: Various, Illinois
REQNUMBER: 1403869
