Representative

Representative

  Not Disclosed

  Scottsdale, AZ

  6.0 Months

  Not Disclosed

  Not Disclosed

  Pharmaceutical

  $13.73/hour - $15.73/hour

Job Description

The Representative II employee will work closely with several different teams within Provider Network Services including the RFI Team and Pharmacy Credentialing. The RFI Team's efforts will be primarily responsible for aiding incoming day-to-day activities. Our RFI Team handles time-sensitive requests required by law or in support of legal processes external to our company. Other areas, including the Pharmacy Credentialing Team, will be to aid other employees and team leads with workloads in order to meet internal/external goals and guarantees.

Must maintain compliance at all times with CMS and department standards.

Customer service focus. Basic experience with laptop use and proficient with Microsoft products including, Outlook, MSWord, and MS Excel. Familiar with working under corporate settings as well as having basic experience with Xerox scanning. The position also requires an extensive amount of data entry work as well as organizational skills to prioritize to work loads.

Experience

2 years experience.

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

Position Summary

The CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of 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.

Education
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.

MUST: have knowledge of HIPAA as they will be dealing with confidential patient information


Note:
Onsite as needed
Mon-Fri 8:30-5pm but open for discussion. Some flexibility with start time - 40hrs a week regardless
Mon-Fri 7:00-3:30 (flexible start and end time - 8hour Shift) 1 shift hours
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.