Job Title: Prior Authorization Specialist
Location: Fully Remote
Duration: 12 months contract
Job Description:
The CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of as the client and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
Responsibilities:
Providers to process prior authorization (PA), and drug benefit exception requests on behalf of Aetna as the client and in accordance with Medicare Part D CMS Regulations.
Must apply information provided through multiple channels to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
Responsible for research and correction of any issues found in the overall process.
Phone assistance is required to initiate and/or resolve coverage requests.
Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards.
Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
Experience:
Experience in MSWord and MSExcel. Familiar with medical terminology and knowledge of medical coding. Ability to read and interpret billing documents.
Skills:
Experience in MSWord and MSExcel.
Education:
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.