Coverage Determination Specialist

📋 Description

• Review and respond to CD requests for Medicare and Commercial plans.
• Receive calls from pharmacies, physicians, and members regarding CD status.
• Initiate calls to physicians, pharmacies, and members when more info is needed.
• Generate calls, faxes, and letters to pharmacies, physicians, and members about CD resolutions.
• Document CD inquiries, issues, status, and resolution per policies.
• Review faxes and emails and create new Medicare/Medicaid or Commercial cases.
• Support pharmacists in gathering information to support exceptions (formulary or other requests).
• Ensure CMS compliance for coverage determinations.
• Complete other CD related tasks as assigned.

🎯 Requirements

• Associate degree in Pharmacy Technician (or equivalent experience).
• 3+ years of customer service experience.
• Experience with Microsoft Office tools (Outlook, Excel, PowerPoint, Word).
• Fluency in English and Spanish.
• Rotating shifts, including nights, weekends, and holidays.

🎁 Benefits

• Equal opportunity employer; E-Verify.