Position Summary
The Coverage Determination/Appeals Service Representative I is responsible for working and triaging in the data entry related fax queues. The Representative I’s primary responsibilities will be to review each document with accuracy and place the case in the proper queues.
Further responsibilities include researching reports, maintaining complete, timely and accurate documentation of Coverage Determination/Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed.

In this role, Coverage Determination Representative I, contractors will be responsible for:
Utilizing multiple software systems to create Medicare Prior Authorization case reviews
Meeting or exceeding government mandated timelines
Complying with turnaround time, productivity, and quality standards
Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

Duties
Responsibilities
1. Review Fax documents appropriately and forward to appropriate queues
2.Update and maintain knowledge of relevant process, regulation and clinical material.
3.Provide assistance or guidance in partnership with learning and innovation when needed
4.Participate in developmental discussions receiving feedback with Supervisor

Experience
Previous medical insurance background preferred but not required.

Education
High School diploma or GED

Position will require schedule flexibility including rotations through Nights, Weekends and Holiday Coverage. All other duties are required to meet business needs.

Notes:
Remote
Shift: Training Hours are 9a-5:30p EST. Working hours will be a rotating shift between the hours of 8a-8p EST