Job Information
US Tech Solutions Prior Authorization Representative in Remote, Rhode Island
Job Title: Prior Authorization Representative
Location: Fully remote
Duration: 10 months contract
Job Description:
The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility and additional cross training to learn all lines of business. Flexibility for movement to different parts of the business to support volume where needed.
Responsibilities:
Training and working virtually
Utilizing multiple software systems to complete Medicare appeals case reviews
Meeting or exceeding government-mandated timelines
Complying with turnaround time, productivity and quality standards
Conveying resolution to beneficiary or provider via direct communication and professional correspondence
Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
Experience:
At least two years of general business experience that includes problem resolution, business writing, quality improvement, and customer service
Six months of working in a virtual role where the supervisor is not physically in the same space
Six months of PBM/pharmaceutical-related work strongly desired
Required Qualifications:
Working independently but be self-aware enough to know when to ask for help
Be technically capable of understanding troubleshooting steps and be able to communicate the results to leaders or IT
Ability to effectively communicate verbally with members and prescribers while managing multiple software systems
Accountable and results-driven
Critical thinker/problem solver
Receptive to constructive feedback and flexible in adapting to change
Ability to effectively plan, prioritize, and organize time and workload
Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
Proficient in navigation of multiple computer applications
Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
Ability to type more than 30 WPM.
Skills:
Prior Authorization
Medicare and Medicaid
Call handling experience.
PBM
Education:
High School diploma or GED
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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