Representative IIRepresentative II

Monroeville, PA 15146

Posted: 03/19/2019 Category: Customer Service Job Number: 25875

Position Summary:
  • Representative will work closely with providers to process prior authorization (PA), and drug benefit exception requests. 
  • Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
  • Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
  • Responsible for research and correction of any issues found in the overall process.
  • Phone assistance is required to initiate and/or resolve coverage requests.
  • Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
  • Must maintain compliance at all times with CMS and department standards.
  • Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.

  • Customer service focus.
  • Basic experience in MSWord and MSExcel.
  • Familiar with medical terminology and knowledge of medical coding.
  • Ability to read and interpret billing documents.
  • The position also requires an extensive amount of data entry work.

  • 2 years experience.
  • Strong Attention to detail.
  • Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality.
  • Proficient computer skills and the ability to navigate in a Windows based environment.
  • Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible.
  • Ability to work in a high pressure, time sensitive environment.
  • Project a professional business image, through phone interaction as well as internal communications.
  • Demonstrated problem-solving ability and attention to detail.
  • Demonstrated sense of urgency with assignments.
  • Strong organizational skills.
  • Strong telephone skills.
  • Ability to read and understand pharmacy/medical terminology.
  • Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
  • Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations.
  • Ability to perform basic mathematic  calculations maybe required.
  • Ability to interpret a variety of work instructions provided through a variety of mediums.
  • Ability to anticipate needs and resolve issues with urgency.
  • Ability to consistently meet quality and production standards.
  • Displays confidence in the ability to learn complex material.
  • Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results.

  • Education High School Diploma or GED required.
  • Associates degree in Business, Accounting or equivalent work experience preferred.

For more information on this position, please contact our office at 877-782-3334.

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