REMOTE Benefit Verification Representative at A-Line Staffing Solutions

***A-Line Staffing is looking for qualified Benefit Verification Representatives or Prior Authorization Representatives for our Pittsburgh location***

Benefit Verification Representative

Hours: 8 hr shift, Must have availability from 7am to 10pm M-F & work rotating weekends Sat & Sun7-5:30

Benefit Verification Representative Job Description:

• The Benefit Verification Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of the client and in accordance with Medicare Part D CMS Regulations.
• The Benefit Verification Representative 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.