Prior Authorization Representative – Medicare – Work From Home

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nging our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

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Position Summary

As a Customer Service Rep II, Operations you will work closely with healthcare providers to process Prior Authorizations (PA) and drug benefit exception requests in a call center environment. In this role, you will play a meaningful role in ensuring member and client satisfaction.

You will be performing all work in accordance with Medicare Part D guidelines. As a Rep II, Operations, you’ll show a high level of attention to detail, verbal and written communications skills, and the ability to problem solve in this dynamic work environment. You’ll be working various assignments that require demonstrated urgency and the ability to meet set timelines. You’ll have the opportunity to project a professional business image through phone interactions as well as internal communication.

Your responsibilities will include: Working incoming cases via phone (primarily) or fax to process coverage requests from members or prescribers – Conducting outreach to patients and providers, and obtaining additional information needed to process requests – Researching and correcting any issues found in the overall process – Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed – Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations – Solving practical problems and dealing with multiple concrete variables in standardized situations – Performing basic mathematical calculations – Ensuring all cases are properly closed – Ability to interpret a variety of work instructions provided through multiple systems.

In this role, you would have flexibility to work any shift between 7:00am – 8:00pm CST (Monday – Friday) and10:00am – 2:00pm CST (Saturday).

 

This position is full-time and offers overtime during our business peaks. We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for
employees, we also offer ten paid holidays.

 

Required Qualifications
6+ months of customer service Pharmacy, Healthcare or related experience Microsoft Suite Experience

 

Preferred Qualifications
Call center experience PBM environment experience Experience in a role requiring maintenance of patient confidentiality Proficient computer skills and the ability to navigate in a Windows based environment including ability to toggle between multiple programs, ability to navigate web based systems as well as DOS based systems, and adaptable to system changes and upgrades.

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