Representative IIRepresentative II
101 Mall Boulevard Monroeville, PA 15146
- 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.