You could be the one who changes everything for our 28 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.Pharmacy Technician AppealsPosition Purpose: The Pharmacy Technician may perform duties in Medicare Part D/Part B, Appeals, Medicare Part D Operations and State Health Programs Pharmacy Operations or Prior Authorization.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 with Appeals, Grievances, Billing and/or Claims, preferred.License/Certification: Valid Pharmacy Technician License preferred.Training: 8am-4:30pm or 10am-6:30pm Monday – Friday (In your own time zone) for training the first 2 weeks, then 10am-6:30pm 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 time zone) with possible Saturday shift rotation after training.Pay Range: $18.66 - $31.73 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.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.Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act