Coverage Determination/ Appeals Service Representative I

SGS_JOB_2602

Pharmacy
 Texas
Data Entry
Prior Authorization
Medicaid
Coverage Determination
Coverage Appeal Rep.

Contract - 06+ Months

Location (mandatory): Hybrid in San Antonio, TX 78238 The Coverage Determination/ Appeals Service Representative I is responsible for working and triaging in the data entry related fax queues. The Representative I’s primary responsibilities will be to review each document with accuracy and place the case in the proper queues. Further responsibilities include research reports, maintaining complete, timely and accurate documentation of Coverage Determination/ Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed. Position will require schedule flexibility including rotations through Nights, Weekends and Holiday Coverage.

Job Responsibilities:

  • Review Fax documents appropriately and forward to appropriate queues
  • Update and maintain knowledge of relevant processes, regulations and clinical material.
  • Provide assistance or guidance in partnership with learning and innovation when needed
  • Participating in developmental discussions receiving feedback with Supervisor

Skills:

  • This is a Hybrid position; colleagues will work from office location and work virtually from home. Requirement for hybrid to report to office 3 days a week. Must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed

Education/Experience:

  • Verifiable High School diploma or GED required

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