Prior Authorization Representative - Medicare Part D
Prior Authorization Representative - Medicare Part D
Managed Staffing, Inc.
United States
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See who Managed Staffing, Inc. has hired for this role
Job Title: Prior Authorization Specialist - Medicare Part D
Location: All over USA
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, and complying with turnaround time, productivity, and quality standards. You will convey resolution to beneficiaries or providers via direct communication and professional correspondence, while acquiring and maintaining knowledge of relevant and changing Medicare Part D guidance.
Key Responsibilities
Location: All over USA
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, and complying with turnaround time, productivity, and quality standards. You will convey resolution to beneficiaries or providers via direct communication and professional correspondence, while acquiring and maintaining knowledge of relevant and changing Medicare Part D guidance.
Key Responsibilities
- Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM, and major medical benefits, prior authorizations, and appeals processing.
- Handle both inbound and outbound calls in a fast-paced environment.
- Organize, detail-oriented, and able to document cases clearly and accurately per program guidelines.
- Excellent communication skills for both internal and external interactions.
- Knowledge of Medicare benefits, enrollments, and LIS assistance.
- Plan and organize work assignments, set priorities, and complete work with minimal supervision.
- Adhere to company service policy and program guidelines set by the department.
- Participate in cross-training to perform all roles within the department.
- Communicate effectively and professionally with program partners to ensure the best possible service.
- Perform other duties as assigned.
- At least two years of general business experience, including problem resolution, business writing, quality improvement, and customer service.
- Six months of working in a virtual role without a supervisor in the same space.
- Six months of PBM/pharmaceutical-related work is strongly desired.
- Ability to work independently but self-aware enough to know when to ask for help.
- Technically capable to understand troubleshooting steps and communicate results to leaders or IT.
- Effective verbal communication skills with members and prescribers while managing multiple software systems.
- Accountable and results-driven.
- Critical thinker and 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 two workstation monitors.
- Ability to type more than 30 WPM.
- High School Diploma or GED required.
- Associate's degree in Business, Accounting, or equivalent work experience preferred.
- Training: Monday to Friday, 8:00 AM - 4:30 PM CST
- Post Training: Schedule falls within Monday to Friday, 7:00 AM - 8:00 PM CST
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Seniority level
Entry level -
Employment type
Contract -
Job function
Health Care Provider -
Industries
Hospitals and Health Care
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