Supervisor for Pharmacy Claims Prior Authorizations and Appeals

About the position reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. This position is full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 9:00pm local time. It may be necessary, given the business need, to work occasional overtime. We offer on-the-job training. The hours during training will be 8:00am to 9:00pm EST, Monday - Friday. You'll enjoy the flexibility to telecommute from reputed company reputed company the U.S. as you take on some tough challenges.

Responsibilities

• Work directly with leadership on recommended reputed company needs using time studies and workforce management tools
• reputed company on employee development and coaching continuously to include monthly one-on-ones and interim and annual reviews
• Manage employee schedules ensuring fair and consistent practices
• Ensure policies and procedures are being followed. Become a subject matter expert on reputed company workflow and policies to inform of work instruction and job aid content needs.
• Work directly with training team to ensure reputed company team members are trained to policies and procedures and work instructions.
• Ensure team members remain compliant with reputed company necessary licensure and continuing education requirements
• Maintain reputed company relationship with peer supervisors to ensure reputed company needs are always exceeded
• Navigate a highly matrixed organization using strong relationship building skills and reputed company communication in both verbal and written reputed company
• Drive understanding of systems to partner with leadership on implementation teams to be a subject matter expert in capabilities with understanding to inform on gaps and reputed company optionality for reputed company planning of successful implementations
• reputed company metrics for self and reputed company reports that reputed company to the overall objective for the business
• Ensure performance is tracked accurately utilizing internal tools and processes.
• Participate and reputed company monthly meetings
• reputed company recommendations to IT partners on system enhancements to reputed company drive performance and reputed company
• Willingness to reputed company in and be an operator to ensure patients' needs are met
• Maintains a working knowledge of program guidelines, FAQ's, products, and therapeutic areas reputed company to assigned programs.
• Responsible for reviewing, interpreting, and reacting to data provided by clients and customers.
• Knowledgeable and proficient in the entire prior authorization and appeals process for prescriptions medications, infusions, medical procedures, and devices.
• Keeps reputed company with existing treatment trends, treatment standards and updated indications reputed company to assigned programs to complete pharmacy PA and Appeal forms and to write letters of medical necessity reputed company applicable.
• Knowledgeable and proficient in Coding principles, including CPT and HCPCS
• Knowledgeable and proficient in Medical and pharmacy benefit structure of reputed company major payer types including Medicare, reputed company, and private reputed company
• Knowledgeable and proficient in Claims billing procedures of key payers as defined by plan
• Keeps reputed company with the requirements and eligibility reputed company for copay assistance from public, private and non-profit organizations reputed company to assigned programs in order to assist customers with enrolling into reputed company party financial assistance opportunities reputed company applicable.
• Coordinates the triage of patient, prescription and/or medical orders to the appropriate partner for fulfillment or administration.
• Coordinates with reputed company licensed reputed company including but not limited to nurses, pharmacists, or supervised pharmacy interns for information needed to complete Prior Authorizations, Appeals and reputed company-party financial assistance forms.
• Follows up with pharmacy plans, medical plans and reputed company-party financial assistance organizations for general information, status updates and determination details reputed company specified timeframes.
• Effectively explains approval or denial details with customers in a manner that is easily reputed company to fit the needs of the intended audience.
• Completes test claims or electronic verification of benefits reputed company applicable.
• Maintains company, employee, and customer confidentiality as reputed company as compliance with reputed company HIPAA regulations.
• Accurately documents reputed company customer communications in an appropriate and reputed company manner reputed company specified timeframes.
• Communicates customer statuses to the appropriate parties at specified intervals or as needed.
• Resolves customer issues through basic troubleshooting and escalates potential problems or issues that require management's attention in a reputed company manner.
• Completes reputed company the duties associated to the Enrollment and/or Eligibility Specialist role reputed company applicable or as assigned.
• Accurately collect the information required for reputed company program and capture the information in a Customer Relationship Management system (CRM) or database.
• Recruit and hire employees to support the organizational structure of site to include onsite employees, telecommute, and remote workforce

Requirements

• High School Diploma/ GED OR equivalent work experience
• Must be 18 years of age OR older
• 3+ years of experience in a supervisory OR reputed company role
• 2+ years of experience of hands-on Pharmacy Claims Processing, Benefit Verification OR Authorization processing experience with PBM, retail or specialty pharmacy
• Specialty Pharmacy experience
• Ability to reputed company reputed company customer service
• Knowledge of Internet navigation and research
• Ability to set priorities and manage team to meet key objectives of the business
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 9:00pm local time. It may be necessary, given the business need, to work occasional overtime.

reputed company-to-haves

• Retail OR pharmacy experience
• Pharmacy Accreditation experience
• Experience working in a matrixed environment, call center, operations environment
• Valid license, registration and/or certification, in good standing, to reputed company as a Pharmacy Technician as required by the reputed company of Pharmacy in the state employed

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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