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انتهت بتاريخ ١ أبريل ٢٠٢٦
وصف الوظيفة
Prior Authorization Specialist 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.
المسؤوليات
- Utilizing multiple software systems to complete Medicare appeals case reviews
- Meeting or exceeding government mandated timelines
- Conveying resolution to beneficiary or provider via direct communication
- Effectively manage work volume by handling inbound calls/fax/ePA requests
- Identify and elevate clinical inquiries to the pharmacist team
المؤهلات
- 0-3 years in a customer service or call center environment
- Six months of PBM/pharmaceutical related work strongly desired
- At least two years of general business experience
- High School diploma or GED