Title: *Representative II
Shift: Training Hours are 9a-5:30p EST. Working hours will be a rotating shift between the hours of 8a-8p EST
*Must provide internet speed test on the resume (INCLUDE SCREEN SHOT) - www.speedtest.net
Position Summary:
Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests as the client 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 clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
Customer service focus. Basic experience in MSWord and MSExcel. Familiar with medical terminology and knowledge of medical coding. Ability to read and interpret billing documents. The position also requires an extensive amount of data entry work.
Duties:
- Utilizing multiple software systems to complete Medicare Prior Authorization 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
- Customer service focus
- Basic experience in MSWord and MSExcel.
- Familiar with some medical terminology.
- Ability to read and interpret billing documents.
- The position also requires an extensive amount of data entry work.
Experience:
2 years-experience any related experience.
Education:
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.
