Cvs Prior Authorization Remote Jobs in Tennessee

With 150+ locations in 17 states, QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. At QualDerm we are united in our purpose: to educate, protect, and care for your skin. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you! 

Our mission is to educate communities and healthcare professionals about the importance of skin health; including skin cancer prevention, risk factors and how to achieve healthy skin through annual skin exams and dermatologic care.

We strive to provide the latest proven, proactive and comprehensive dermatologic care to populations in the expanding geographies we serve by making high-quality skin care timelier and more accessible all while creating a rewarding work environment for our providers and employees. Not only do we offer aggressive compensation and benefit packages, but we offer a culture that is unsurpassed!

Purpose:

The purpose of a Triage Specialist is to perform effective telephone triage to support dermatology patients based on their needs.

Work Location & Training: This position requires in-office training at our Lebanon (LBN) location for approximately the first 1-2 months. Upon successful completion of the training period, the position will transition to fully remote/work-from-home.

Essential Duties and Responsibilities:

• Answer incoming phone calls and return voicemails; address patient questions, provide guidance, or direct calls to the appropriate department.
• Identify and appropriately relay stat or emergent situations to providers.
• Communicate pathology and biopsy results to patients and coordinate follow-up visits or minor procedures as needed.
• Manage refill requests efficiently and accurately.
• Evaluate and document wound concerns, escalating to providers when necessary.
• Navigate EMA/EMR systems to process faxes, tasks, chart updates, and documentation.
• Create new patient charts, schedule new patient appointments, and ensure accurate note preparation.
• Provide patient education and answer questions using clear communication and basic medical terminology.
• Document all patient interactions thoroughly and accurately in EMA.
• Schedule surgeries and procedures according to provider-specific templates, guidelines, and availability.
• Prioritize skin cancers based on type, subtype, size, location, and aggressiveness to ensure timely care.
• Explain Mohs procedures and set expectations for patients undergoing surgery.
• Conduct pre-operative assessments and coordinate necessary prescriptions-such as antibiotics-under provider direction.
• Manage pre-certification and prior authorization requirements for procedures.
• Monitor and respond to incoming emails to ensure timely communication with patients, providers, and staff

Requirements

• High School Diploma or higher
• 3 years minimum experience as a Medical Assistant
• CCMA/RMA Certification preferred
• Excellent verbal and written communication skills
• Experience with answering phones, voicemails, medical understanding of surgical procedures, common pathology diagnoses, stat emergent situations, charting and patient scheduling.

Benefits

Benefits of joining Qualderm Partners:

• Competitive Pay - Attractive compensation to reward your hard work
• Comprehensive Health Coverage - Includes Medical, Dental, and Vision plans to keep you covered
• Generous 401(k) Plan - Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting
• Paid Time Off (PTO) - Unlimited, unaccrued paid time off plus 6 company paid holidays
• Company-Paid Life Insurance - Peace of mind with basic life coverage, with the option for additional plans
• Disability Protection - Short-term and long-term disability coverage to protect you in unexpected circumstances
• Additional Wellness Plans - Accident, critical illness, and identity theft protection plans for extra security
• Employee Assistance Program (EAP) - Access confidential support for personal or work-related challenges
• Exclusive Employee Discounts - Save on products and services with special discounts just for you
• Referral Bonus Program - Earn bonuses by referring qualified candidates to join the team

QualDerm Partners is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Applicants must be currently authorized to work in the United States in a full-time basis.