Prior Auth Jobs in Rhode Island (NOW HIRING)

$18-$19 per hour

remote, RI

Contract

Job Summary:

• The Tech I Prior Auth. 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 Tech I 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.

Responsibilities:

• Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards. 40%

• Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers. 40%

• Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc.). 10%

• Identify and elevate clinical inquiries to the pharmacist team as appropriate. 5%

• Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. 5%

Experience:

Preferred 0-3 years work experience required in a customer service position with high volume call center experience; preferably in healthcare, social services, or a similar service position.

Education:

• Verifiable High School diploma or GED is required. Associate Degree or Bachelor's Degree: If neither degree held, then equivalent years of work experience is preferred, Other Certificates or Licenses (List): Active pharmacy technician license per state requirements, or active national certification. Trainee license in states where applicable are preferred.

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 (http://www.ustechsolutionsinc.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.