Prior Authorization Representative

1 week ago


Atlanta, United States US Tech Solutions Full time

Duration: 06 Months

Job Summary:

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

Responsibilities:

Working independently but be self-aware enough to know when to ask for help

Be technically capable to understand trouble-shooting 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

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

Education:

  • High School Diploma or GED required
  • Bachelors degree in related field or equivalent work experience preferred

Skills:

  • Call center, Prior authorization


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