Logo for US Tech Solutions

Prior Authorization Coordinator

US Tech Solutions

Role overview

Qualifications

  • 0-3 years in a customer service or call center environment managing 75 calls/day
  • Six months of PBM/pharmaceutical related work strongly desired
  • At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service

Responsibilities

  • Utilizing multiple software systems to complete Medicare appeals case reviews
  • Meeting or exceeding government mandated timelines
  • Complying with turnaround time, productivity and quality standards
  • Conveying resolution to beneficiary or provider via direct communication and professional correspondence

Key facts

Hard skills

Prior Authorization Medicare Medicaid Internal Documentation Business Writing

Other skills

  • Troubleshooting (Problem Solving)
  • Customer Service
  • Communication
  • Physical Flexibility

About the company

US Tech Solutions logo

US Tech Solutions

Staffing & Recruiting

USTECH SOLUTIONS is the largest privately owned diversity workforce partner with a global footprint. For 20+ years, we have partnered with leading MSPs and some of the world’s largest enterprises to deliver a flexible workforce. We serve Fortune 500 giants and growing businesses alike, reinventing the role of humans in a digital workforce. ‘Reinventing Human’ is about connecting you with top talent and seamlessly integrating new hires into your programs through our next gen AI powered Talent platforms. As the largest private diversity supplier in the US, we champion inclusion and unlock hidden potential. We work with leading MSPs and are a trusted strategic partner to the world’s top brands. At USTECH SOLUTIONS, we're inverting the talent hiring pyramid by offering a range of solutions from curated talent pools, workforce management services, and IT services resourcing to IC compliance. Our legacy and close affinity to the computing industry has equipped us with the expertise and vision to provision AI platform solutions that help organizations to innovate faster. Considering Statement of Work? Meet US Tech Digital (ustechdigital.com). We're helping businesses achieve digital leadership through our tailored SOW solutions, utilizing market-leading technology products and our proprietary in-house developed platform solutions. Explore our full range of services and solutions by visiting our website: ustechsolutions.com

Company details

Company typeLarge
IndustryStaffing & Recruiting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

Your match analysis

See how your profile stacks up against this role.

We compared the job requirements to your profile to show where you're strong and where you fall short.

Job description

Location: Fully remote

Duration: 12 months contract


Job Description:
  • 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.
  • The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
  • Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations.
  • 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 Learning Advocates and management team as needed.
  • Must maintain compliance at all times with CMS and department standards.
  • Position requires schedule flexibility and additional cross training to learn all lines of business.
  • Flexibility for movement to different parts of the business to support volume where needed.
 
Responsibilities:
  • Utilizing multiple software systems to complete Medicare appeals case reviews
  • Meeting or exceeding government mandated timelines
  • Complying with turnaround time, productivity and quality standards
  • Conveying resolution to beneficiary or provider via direct communication and professional correspondence
  • Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
  • Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards.
  • Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
  • Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
  • Identify and elevate clinical inquiries to the pharmacist team as appropriate.
 
Experience:
  • 0-3 years in a customer service or call center environment managing 75 calls/day.
  • Six months of PBM/pharmaceutical related work strongly desired
  • At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
 
Skills:
  • Prior Authorization
  • Medicare and Medicaid
  • Call handling experience.
 
Education:
  • High School diploma or GED
 
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
 
US Tech Solutions is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Apply once. Then go straight to the hiring manager.

After you apply, unlock the direct contact details of the people who actually make the call. A quick follow-up makes you 5x more likely to land an interview.

MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
Unlocked after you apply
·

Related jobs

Rhode Island (USA)

Other jobs at US Tech Solutions

Premium

Reach out to the hiring manager directly.

Gain access to the contact details of the hiring managers who actually decide, and reach out to network with them directly. That, plus more when you upgrade:

  • Full match report with fit score and gaps
  • Career diagnostics on how recruiters read you
  • Curated company matches and warm intros
  • 48h early access to new roles

Cancel anytime.