Remote Prior Authorization Analyst Jobs in Rhode Island

Remote
Position Summary
This position takes in-coming calls from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.
Key Responsibilities:
Handle incoming calls from members, providers, and other healthcare professionals.
Deliver exceptional customer service while guiding callers through the prior authorization process.
Review clinical documentation to determine completeness and eligibility based on established criteria.
Accurately document all approvals and denials in a timely manner.
Escalate clinical judgment calls and complex inquiries to the pharmacist for further evaluation.
Maintain compliance with regulatory requirements and internal protocols.
Required Qualifications:
Minimum of 1 year of experience as a pharmacy technician in an support or call center role.
National Pharmacy Certification or State License is PREFERRED in good standing
Eligible for state registration, certification, or licensure as PREFERRED by state regulations.
Strong computer skills, including proficiency in word processing and spreadsheet applications.
Excellent verbal and written communication skills.
At least 1 year of experience in a high-volume customer service or healthcare call center environment.
Experience Requirement
Minimum 1 year of relevant experience required.
Certification / Licensure
Pharmacy Technician certification or licensure is NOT required.
Certification/licensure is preferred but not a mandatory qualification.
Top Skills
High-Volume Healthcare Call Center Experience
Experience handling a fast-paced inbound call environment.
Healthcare customer service experience preferred.
Pharmacy Technician Knowledge
Understanding of pharmacy terminology, medication processes, and prior authorization workflows.
Pharmacy Technician experience required.
Documentation & Computer Proficiency
Ability to accurately document call activity, approvals, denials, and case information.
Comfortable navigating multiple systems simultaneously.
Remote Work Requirements
Must have hardwired internet connectivity (Wi-Fi only is not acceptable).
Candidates must provide an internet speed test during submission.
Strong basic computer skills are required.
Must be comfortable working on a computer throughout the workday.
Smartphone required to access and utilize the PING application.
Must have private workspace
Key Candidate Profile
1+ year Pharmacy Technician experience.
1+ year high-volume customer service/call center experience.
Strong communication skills.
Comfortable working in a structured, metric-driven environment.
Reliable attendance during the mandatory 7-week training period.
Duties
At least 1 year experience as a pharmacy technician coordinating activities in an administrative support function.
National pharmacy technician certification. Eligible for state registration, certification or licensure per state regulations.
Advanced computer skills including word processing and spreadsheet utilization.
Excellent customer service skills (written and verbal) a must.
Experience
Minimum (1) year 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.
Notes:
Training: (8a-4:30pm CST M-F ) Shifts 8am-4:30pm CST
Fully remote (never coming onsite)
Daily Call Volume
Average daily volume: 60-100 calls per day
Approximately 8 calls per hour, though volume may fluctuate higher or lower depending on business needs.
Calls are primarily inbound, with some outbound activity as needed.
Training
Training lasts for the first 7 weeks of the assignment.
Training Schedule: Monday-Friday, 8:00 AM - 4:30 PM CST
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status