Rep II, Operations - Medicare B Prior Auth IB Phone Tech

This is a RAMP Order open to suppliers 8/26

Safety Sensitive Role

Supplier MAX Bill Rate ***

MAX Bill Rate ***

PLEASE REVIEW WITH CANDIDATE, COMPLETE, AND COPY OF TOP OF RESUME

1. Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F 800A - 4:30P CST, All time off needed should be discussed and disclosed during this initial review.

-Do you have any conflicts with the training schedule or time off planned during assignment duration?

2. After training, our hours of operation are M-F 7:00A-6:00P CST

-Do you have any conflicts working an assigned 8-hour shift between 7:00A - 6:00P CST?

3. This is a work from home (WFH) position; must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.

-Do you have a separate workspace with no interruptions?

-PLEASE PROVIDE CANDIDATE INTERNET SPEED -

4. Must be able to sit and focus on work for the duration of shift.

-Are you able to sit and focus with no interruptions for entire shift?

5. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.

-Do you have data entry experience and able to type a minimum of 30 wpm?

6. Pharmacy or medical background is preferred.

-Do you have a Pharmacy or Medical background?

7. Successfully worked independently in a data entry, productivity driven role is preferred

-Are you able to work independently?

8. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal

-Do you feel you have the engagement and positive attitude to work this assignment?

In this role, you will be responsible for:

• Training and working virtually

• Utilizing multiple software systems to complete Medicare appeals case reviews

• Meeting or exceeding government mandated timelines

• Complying with turnaround time, productivity and quality standards

• Conveying resolution to beneficiary or provider via direct communication and professional correspondence

• Acquiring and maintaining basic knowledge of relevant and changing Medicare B guidance

Required Qualifications:

• Working independently but be self-aware enough to know when to ask for help

• Be technically capable to understand trouble-shooting steps and be able to communicate the results to leaders or IT

• Ability to effectively communicate verbally with members and prescribers while managing multiple software systems

• Accountable and results driven

• Critical thinker/problem solver

• Receptive to constructive feedback and flexible in adapting to change

• Ability to effectively plan, prioritize, and organize time and workload

• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment

• Proficient in navigation of multiple computer applications

• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors

• Ability to type more than 30 WPM

Position Summary:

In this role, you will be responsible for:

• Training and working virtually

• Utilizing multiple software systems to complete Medicare appeals case reviews

• Meeting or exceeding government mandated timelines

• Complying with turnaround time, productivity and quality standards

• Conveying resolution to beneficiary or provider via direct communication and professional correspondence

• Acquiring and maintaining basic knowledge of relevant and changing Medicare B guidance

Required Qualifications:

• Working independently but be self-aware enough to know when to ask for help

• Be technically capable to understand trouble-shooting steps and be able to communicate the results to leaders or IT

• Ability to effectively communicate verbally with members and prescribers while managing multiple software systems

• Accountable and results driven

• Critical thinker/problem solver

• Receptive to constructive feedback and flexible in adapting to change

• Ability to effectively plan, prioritize, and organize time and workload

• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment

• Proficient in navigation of multiple computer applications

• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors

• Ability to type more than 30 WPM

Duties:

Key Responsibilities: Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing. Ability to work in a fast paced environment, handling both inbound and outbound calls. Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. Good communication skills are essential, both internal and external. Knowledge of Medicare benefits, enrollments and LIS assistance. Plans and organizes work assignments, set priorities and completes work with a minimum of supervision. Adheres to the service policy and principles of the company, as well as the program guidelines set by the department. Participates in cross-training to perform all roles within the department. Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners. Other duties as assigned. Physical Demands: May sit, stand, stoop, bend and walk intermittently during the day. May sit or stand seven (7) to ten (10) hours per day. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Visual acuity to see and read fine prints. Specific vision abilities required by this role include close vision, color vision and the ability to adjust focus. Must be able to hear normal voice sounds. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role. Work Environment: Virtual environment with HIPAA protection

Experience:

At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service

• Six months of working in a virtual role where the supervisor is not physically in the same space

• Six months of PBM/pharmaceutical related work strongly desire

Education:

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