CSR - Diabetes Utilization Management

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Description

HIRING REMOTE EXPERIENCED DIABETIC CSR'S IN THE FOLLOWING STATES: AL,FL, GA, IN, LA, MS, NC, SC, TN, TX, VA, & WV

• MI RESIDENTS WITHIN 40 MILES OF 48393 WILL BE FULL TIME IN OFFICE

ARE YOU LOOKING FOR GROWNING COMPANY WITH ROOM FOR ADVANCEMENT?

APPY NOW!

• Full Benefits after 30 Days!! PTO after 90 Days! and MORE!!!!

The Diabetes Utilization Management Team is comprised of Prior Authorization, Quality Assurance, and Provided/ Vendor Services functions that work collaboratively to support timely and accurate access to diabetes therapies.

11/18 TARGET START DATE

CS Representatives will require the ability to multi-task and utilize multiple computer applications to access and enter data in member accounts. Representatives will also be required to conduct themselves in a HIPAA compliant and ethical manner. Duties include, but are not limited to: Incoming and outgoing calls, new account creation, insurance verification, document processing, order set up and management. Representatives will be required to communicate professionally with members, caregivers, guardians, medical professionals, and co-workers.

Core Responsibilities:

• Review and process requests for diabetes-related therapies, including CGMs, insulin pumps, and testing supplies
• Ensure accuracy and completeness of documentation to support timely order processing and authorization approvals
• Evaluate requests against payer guidelines, medical policies, and coverage criteria
• Communicate with leadership, provider offices, vendors, and patients to obtain required documentation and clarify orders
• Provide clear and professional written and verbal updates on order and documentation status
• Collaborate with clinical staff (nurses, pharmacists) for medical reviews and escalations
• Prioritize workload to meet turnaround time expectations and service level agreements
• Stay current on payer policy updates, diabetes technologies, and internal workflows

Prior Authorizations

• Submit and track prior authorization requests with insurance providers
• Interpret and apply payer-specific requirements, including medical necessity criteria
• Identify and resolve authorization denials; initiate appeals and obtain supporting documentation as needed
• Follow through on pending authorizations to ensure timely determinations
• Maintain compliance with payer guidelines and internal quality standards

Quality Assurance

• Perform quality reviews and participate in routine order and account audits
• Ensure accuracy across orders, documentation, and payer requirements prior to release
• Identify workflow or eligibility gaps and escalate trends for process improvement
• Take ownership of accounts requiring correction and ensure issues are fully resolved
• Provide feedback to team members and leadership to support ongoing quality improvement

Provider / Vendor Services

• Serve as a liaison between internal teams, providers, vendors, and health plans to support continuity of care
• Conduct detailed account research using internal systems, payer portals, and direct outreach
• Identify, communicate, and resolve issues that may delay patient access to supplies
• Manage escalated or high-priority accounts with a sense of urgency and accountability
• Balance a high-volume workload while maintaining accuracy and attention to detail
• Coordinate with providers, manufacturers, and health plans as needed to resolve complex cases
• Participate in meetings or calls with external partners when required
• Assist with tracking and reporting of team metrics and trend

Requirements

Technical Infrastructure (BYOD)

Equipment: This position requires a Bring Your Own Device (BYOD) setup. Equipment is not provided.

Hardware: You must own and maintain a reliable computer capable of securely running healthcare software.

Preferred Education and Experience:

• 2+ years of experience in a fast-paced Medical customer service role requiring the ability to handle multiple tasks at various stages of completion. D.E preferred.
• Previous experience requiring the ability to effectively use computer system and maintain good records. skills testing is required

Required Education and Experience:

• High school diploma or GED

Other Duties:

All other duties as assigned by management.

Salary Description

$17/hour

Notice of AI Use in Job Application Review

As part of our commitment in creating a fair, efficient, and consistent hiring process we may use artificial intelligence (AI) to help our recruiting teams organize, summarize, and analyze information provided by candidates, including resumes, application responses, and other materials submitted during the application process.AI may be used to identify patterns, highlight relevant skills, and experience, and assist in comparing a candidate's qualifications with the requirement of a specific role. These tools are to improve efficiency and consistency while supporting more informed hiring decisions, which will ultimately be made by the hiring team.