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Form of workJob Description
Description:
• Conducts an initial level medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the member’s benefit.
• Routes cases directly to the pharmacist/medical director for final determination, as directed.
• Issues verbal and written member notification as required.
• Reviews and interprets prescription and medical benefit coverage across all lines of business including Medicare D to determine what type of Prior Authorization review is required, documents any relevant medication history and missing information to assist the pharmacist/nurse/physician in the review process.
• Works with requesting providers, clinical pharmacists, and other internal staff, as appropriate, in determining whether specific case presentation meets the criteria for approval according to the medical or prescription drug policy and specific coverage criteria.
• Contacts pharmacies and physician offices as necessary to obtain clarification on Prior Authorization requests and drugs being billed through the point-of-sale system and/or medical claim system in order to optimize the member experience..
Skills:
Prior authorization, Insurance verification, Health care, Insurance, Data entry, Medical terminology, Call center, Customer service, Microsoft office, Insurance eligibility, Coordination of benefits, EMR
Qualifications:
• High school diploma with a minimum of two years’ experience in health-related field is required. Associates degree preferred.
• Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist strongly preferred.
Experience Level:
Expert Level
About Aston Carter:Please Note: Scammers are posing as Aston Carter. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.
At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.
Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
