Job Description
SUMMARY:
- Handle high-volume inbound calls from members, providers, and pharmacies.
- Assist with criteria-based Prior Authorization requests.
- Review and process PA requests received by phone, fax, and ePA.
- Maintain accurate and timely documentation of reviews, approvals, and denials.
- Make outbound calls and respond to department mailbox inquiries.
- Coordinate with internal teams regarding PA status and results.
- Escalate clinical questions and judgment calls to the pharmacist team.
- Provide professional and courteous customer service.
- Perform additional administrative duties as assigned
Respnsibilities:
- 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
Numbers & Facts
| Location | (Remote) |
| Job Type | Contractor |
| Salary | $20–$21 Per Hour |
| Year Founded | null |
Qualifications
- 1+ year Pharmacy Technician experience.
- 1+ year high-volume customer service/call center experience.
- Strong communication skills.
- At least 1 year of experience in a high-volume customer service or healthcare call center environment.
- Comfortable working in a structured, metric-driven environment.
- Reliable attendance during the mandatory 7-week training period.
- Strong computer skills, including proficiency in word processing and spreadsheet applications.
- Average daily volume: 60-100 calls per day.
Skills
- Certified Pharmacy Technician (CPhT)
- Pharmacy
- prior authorization
- Inbound Call Centers
Skills
Administrative Skillsunmatched
Call Volumeunmatched
Certified Pharmacy Technician (CPhT)unmatched
Customer Support/Serviceunmatched
Documentationunmatched
Environmental Protection Agency (EPA)unmatched
Pharmacyunmatched
Telephone Skillsunmatched
Time Managementunmatched
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