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Remote Customer Service Representative
1 month ago
Description
We're looking for a
Remote Customer Service Representative , working in
Insurance
industry in
Atlanta, Georgia, United States .
Collect structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and/or corresponding forms.
Screen requests based on guidance given by online prior authorization tools.
Approve prior authorization requests if the data collected meets the approval specifications.
Refer prior authorization requests that do not meet the approval specifications to a pharmacist for clinical review.
Respond to contacts independently ranging from routine to moderate complexity. May seek assistance with health care professional service issues of substantial complexity.
Perform research to respond to inquiries and interprets policy provisions to determine most effective response using established departmental procedures, HIPAA regulations, and corporate policies.
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