Impress employers and recruiters.
Choose from hundreds of resume examples.
Impress employers and recruiters.
Choose from hundreds of resume examples.
About the Role
Reviews and processes formulary change requests, submits and maintains formulary change requests to Health Net’s pharmacy claims processor, generates, maintains and reviews Formulary Status Grids, and performs audits and quality checks on the current formulary status for accuracy and contract compliance. Assists Clinical Pharmacist with formulary database maintenance and website updates. Performs various assignments for pharmacy audit and recovery functions, reviews paid claims for discrepancies, corresponds with pharmacies, and updates the Access database. May perform duties in areas such as Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D/Part B, Appeals, Medicare Part D Operations and State Health Programs Pharmacy Operations or Prior Authorization. Reviews requests for prescription drugs and pharmacy benefits, researches and resolves issues, and consults with Clinical Pharmacists or Regional Medical Director on related issues.
Responsibilities
- Reviews and processes formulary change requests from Health Net plans
- Submits and maintains formulary change requests to Health Net’s pharmacy claims processor
- Generates, maintains and reviews Formulary Status Grids
- Uses reports to perform audits and quality checks on the current formulary status for accuracy and contract compliance
- Assists Clinical Pharmacist with formulary database maintenance and updates to company web site
- Performs a variety of assignments required for pharmacy audit and recovery functions
- Reviews paid claims for quantity and/or billing discrepancies
- Corresponds with pharmacies as needed to communicate review finding
- Faxes inquiries to pharmacies related to review findings
- Answers in-coming calls and responds appropriately to faxed correspondence from pharmacies
- Updates Access database with incoming phone calls, faxes and e-mails
- Performs other duties as assigned
- Complies with all policies and standards
- Reviews requests made by physicians, medical groups, pharmacies and members for the use of prescription drugs and pharmacy benefits
- Researches and resolves questions, problems or issues
- May consult with Clinical Pharmacists or Regional Medical Director on related issues
Requirements
- High School diploma or GED required
- 1 year Pharmacy Technician experience
- Customer Service/retail experience preferred
- Valid Pharmacy Technician License preferred
Work Type
- remote
- hybrid
- field
- office
Education Level
- High School diploma or GED
Salary/Compensations
- $19.43 - $32.98 per hour
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work
About the Company
- At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Equal Opportunity
- 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