Prior Authorization and Benefits Specialist (Remote) from A-Line Staffing Solutions

Job Title: Prior Authorization and Benefits Specialist

Pay: $17.50 an hr | Bi-weekly

Job Type: Remote

Shift Options:

• Hours: Mon-Fri 7AM-8:30PM CST. Training hours: Mon-Fri 8AM-4:30PM CST for 4 weeks.

Prior Authorization and Benefits Specialist Overview:

• The Commercial PA Representative I will work closely with providers to process prior authorization PA and drug benefit exception requests on behalf of CVS Health 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.

Prior Authorization and Benefits Specialist Qualifications:

• Must maintain compliance at all times with CMS and department standards.
• Position requires schedule flexibility including rotations through nights weekend and holiday coverage.
• Customer service focus.
• Basic experience in MSWord and MS Excel.
• Familiar with medical terminology and knowledge of medical coding.
• Ability to read and interpret billing documents.
• The position also requires an extensive amount of data entry work.

Prior Authorization and Benefits Specialist Benefits:

• Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

How to Apply:

If you are interested in this position, please apply OR submit your resume to:

Saw Hlaing | shlaing@alinestaffing.com | 412-790-5425