Very administrative in nature - will be reviewing prior auth requests from fax, electronic, and inbound calls.
Will review requests and checking them against pre-determined criteria - sending to Pharmacist for review
Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies. Assists in the mentoring and training of new staff.
Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
Educates providers on how to submit claims and when/where to submit a treatment plan. Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
Requirements
Candidates should have high-speed internet. Oscar provides equipment
Must be a Nationally Certified pharm tech - with 1 year ex.
HS Diploma/GED –
Prior authorizations is a huge plus, but not required as long as you are open to inbound/outbound calls.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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