Clinical Services/Prior Authorization Representative

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Manage incoming and outgoing calls, documenting all calls in the dedicated application for call documentation.
• Handle letters from/to pharmacies, physicians, and healthcare providers in support of the Prior Authorization (PA) department.
• Analyze clinical PAs using the provided clinical protocols, and provide regarding PA requests based on provided documentation.
• Clarify any questions or concerns received from clients and/or internal departments.
• Aids with inquiries related to pre-authorizations referred by the account managers or other departments.
• Use online databases to document recommendations, clinical decisions, and responses.
• Deliver high-quality customer service in a fast-paced, dedicated PA program.
• Supports on training new employees.
• Participates in training, conferences, orientations, and other activities related to your business unit.

Qualifications And Requirements

• Pharmacy technician certification (CPhT) required, registered preferred.
• Prefer 2 years experience working as a pharm tech or as a physician office assistant handling phone calls and reviewing charts.
• 1 year experience contacting other healthcare providers as part of daily job preference.
• Excellent communication skills working in a professional environment.
• Strong organizational skills working under time constraints in a constantly changing environment.
• PC experience to navigate new applications, with intermediate Excel and Word skills preferred.

Physical Demands

This role is primarily sedentary and requires the ability to sit for extended periods (minimum of 7 hours).

The Perks Of Joining Our Team

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Time to Recharge: Paid vacation and holiday pay.
• Focus on Your Wellness: We offer a robust Employee Wellness Program.
• Invest in Your Future: 401(k) with a company match.
• Support System: Employee Assistance Program provides confidential support and counseling.
• Get Rewarded for Referring Great People: Employee referral program.

Ready to start your rewarding journey with us? Apply today!