Pharmacy Coordinator – FWA
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Job Description
Pharmacy Coordinator reviewing fraud, waste, and abuse referrals for Centene’s health plans. Analyzing pharmacy data, supporting investigations, and coordinating member, provider, and pharmacy inquiries.
Responsibilities:
- Review and respond to fraud, waste, and abuse (FWA) referrals, inquiries, and requests from internal and external stakeholders
- Support regulatory requests, reporting, and documentation related to FWA investigations and reviews
- Research and help resolve concerns involving inappropriate billing, waste, and potential FWA activity
- Communicate with members, providers, and pharmacies to gather information and support preliminary reviews
- Generate and analyze reports to identify trends, support investigations, and assist with program oversight
- Contribute to department process improvements and maintain accurate documentation
- Support the pharmacy department's development, coordination, and maintenance of the health plan's pharmacy program
- Receive and respond to provider and pharmacy calls regarding pharmacy benefits
- Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
- Assist departments in educating providers on the health plan’s pharmacy processes
- Assist with the pharmacy utilization review and reporting process
- Assist with member inquiries
- Perform other assigned duties and activities
- Comply with all policies and standards
Requirements:
- 3+ years of pharmacy technician experience, preferably in a managed care environment
- Experience in a dispensing pharmacy environment, such as retail, specialty, long-term care, or mail-order pharmacy
- Medicare and/or Medicaid experience preferred
- Strong attention to detail, analytical thinking, and organizational skills
- Ability to collaborate effectively in a team-oriented environment while managing multiple priorities
- Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook
- Excellent verbal and written communication skills with members, providers, pharmacies, and internal stakeholders
- Interest in fraud, waste, and abuse prevention, compliance, and program integrity
- High school diploma or equivalent
- Prior experience using analysis tools or systems
- Experience in implementing quality process improvement efforts
- Experience documenting requirements, creating training materials, and working directly with end users
- Current state's Pharmacy Technician license preferred
- Availability Monday–Friday, 8:00 AM–4:30 PM Eastern or Central time
Benefits:
- Competitive pay
- Health insurance
- 401K plans
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Incentives may be included in total compensation
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