Location
Providence, RI | United States
Job description
MAX Bill Rate $27.75
The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
The Tech I will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auths received via fax, portal requests, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away from distractions, and must have their own secure private internet services of at least 25mbps download/3mbps upload in order to ensure sufficient speed to adequately perform work duties. Must provide a screenshot of internet speeds with resume. If a licensed Pharmacy Technician provide license number.
Training schedule is approximately three weeks starting 4/1/2024, Monday to Friday 8:00am - 4:30pm CST, then schedule will be assigned: Expected shifts to be 8 hours per day, Monday through Friday between 8am CST and 12AM CST, with potential weekend requirements. ; Qualification Assessment Must Have CVS Caremark Requirements
Prior CVS/Aetna work experience?
No
Verifyable High School Diploma or GED Required
Yes Is this request for Peak Season? Select applicable value
_N/A - Not RAMP Related
Duties
1. Effectively manage work volume by handling inbound calls and fax requests utilizing appropriate courteous and professional behavior based upon established standards.
2. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
3. Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
4. Identify and elevate clinical inquiries to the pharmacist team as appropriate.
5. Other duties assigned, for example faxes, sorting, email boxes, etc.
Required Skills:
- Able to apply basic computer skills. Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
- Must be able to multitask and utilize multiple system applications simultaneously.
- Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.
- Must be able to utilize available resources independently and provide high quality work.
- Must be able to absorb presented information, display motivation, seek development and problem solve.
- Ability to adapt and change with workflow and shifting priorities.
- Must possess excellent written, verbal, grammar, and listening communication skills.
- Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
- Ability to maintain confidentiality of PHI (Protected Healthcare Information).
Experience
Preferred 1-3 years work experience required in a customer service position with high call center volume; preferably in healthcare or a similar service position.
Position Summary
The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
The Tech I 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, portal requests, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
Education
Required: Verifiable High School diploma or GED.
Preferred: Associate Degree or Bachelor's Degree: If neither degree held, then equivalent years of work experience.
Preferred: Other Certificates or Licenses (List): Active pharmacy technician license per state requirements, or active national certification.
What days & hours will the person work in this position? List training hours, if different.
8 hour shift Monday to Friday anywhere between 8:00 am to 12:00 am CST; possible weekends
Type of Start
Class with set start date
Program Office - Point Of Contact
Jennifer East
Is this an in-person, patient-facing role?
No
Onsite Requirements
Fully remote (never coming onsite)
Job tags
Salary
