Archived listing. The details below describe a past opening.
Job Summary In this role, you will manage data entry queues and utilize multiple software systems to create Medicare Prior Authorization case reviews. You will be responsible for reviewing fax documents, placing cases in the proper queues, and ensuring all government-mandated timelines and quality standards are met while handling appeals and requests. Responsibilities Review fax documents accurately and forward them to the appropriate queues. Research reports and maintain complete, timely documentation of Coverage Determination/Appeal requests. Escalate complex issues to pharmacists or management staff as needed. Acquire and maintain knowledge of relevant processes, regulations, and changing Med D guidance. Participate in developmental discussions and receive constructive feedback. Requirements High School diploma or GED required; pharmacy or medical insurance background strongly preferred. Hybrid setup: 2-3 days weekly in the San Antonio office, including an onsite weekend rotation. Dedicated, quiet home workspace with wired internet (minimum 25mbps download / 5mbps upload). Camera must be ON during all virtual meetings and training sessions. Mandatory attendance for 8 weeks of training M-F, 9:00 AM - 5:30 PM EST (no time off permitted). Post-training availability for rotating 8-hour shifts between 8:00 AM - 8:00 PM EST, including weekends. Ability to independently navigate multiple computer applications while utilizing two screens.
salary: $18.7 - $18.71 per hour shift: First work hours: 8 AM - 8 PM education: High School
Responsibilities
Review fax documents accurately and forward them to the appropriate queues. Research reports and maintain complete, timely documentation of Coverage Determination/Appeal requests. Escalate complex issues to pharmacists or management staff as needed. Acquire and maintain knowledge of relevant processes, regulations, and changing Med D guidance. Participate in developmental discussions and receive constructive feedback.
Skills
- Review
- Provide assistance
- guidance in partnership
Qualifications
- Years of experience: 0 years
- Experience level: Experienced
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Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.