The Rep I, Clinical Services takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.

The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

The Intake I (IQA) Associate takes in-bound calls (high volume) 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 requests, and transfers all clinical questions and judgement calls to the nurse or pharmacist. The Intake I (IQA) Associate will also assist with other duties such as outbound calls, monitoring/responding to inquiries in mailboxes and other duties as assigned by the leadership team.

1.Strong Attention to detail
2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
3.Proficient computer skills and the ability to navigate in a Windows based environment
4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible
5.Ability to work in a high pressure, time sensitive environment
6.Project a professional business image, through phone interaction as well as internal communications
7.Demonstrated problem-solving ability and attention to detail
8.Demonstrated sense of urgency with assignments
9.Strong organizational skills
10.Strong telephone skills
11.Ability to read and understand pharmacy/medical terminology
12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required
14.Ability to interpret a variety of work instructions provided through a variety of mediums
15.Ability to anticipate needs and resolve issues with urgency
16.Ability to consistently meet quality and production standards
17.Displays confidence in the ability to learn complex material
18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results

Required Experience:
0–3 years related experience, prior authorization, data entry, customer service

Preferred Experience:
Healthcare industry, call center (minimum 6 months), remote work (minimum 6 months)

Required Qualifications
Ability to apply basic computer skills.
Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable.
Keyboard skills are essential.
Must be able to multitask and utilize multiple system applications simultaneously.
Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

Preferred Qualifications
Prior authorization experience
Must be able to utilize available resources independently and provide high quality work.
Must be able to absorb presented information, display motivation, seek development and problem solve.
Ability to adapt and change with workflow and shifting priorities.
Must possess excellent written, verbal, grammar, and listening communication skills.
Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
Ability to maintain confidentiality of PHI (Protected Healthcare Information).
Associate Degree or Bachelor’s Degree

Education
High School diploma or GED

Notes:
Fully remote
Training schedule is approximately four weeks starting Monday to Friday 8am-4:30pm ET, then schedule will be assigned: Expected shifts to be 8 hours per day, Position requires schedule flexibility.
Weekend and evening shifts may be required.
Permanent schedule to be decided after training.
Phone hours are from 9am-7pm ET.