This is a contract position that will extend 6 months. This position will be remote until COVID restrictions are lifted.
This job captures all inbound requests for utilization review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in the client’s utilization management system for clinical review. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax or phone, and at times may require follow-up calls with physicians or pharmacists.
-Training period is at least two weeks. No time off can be taken during training.
-No planned vacation or any scheduled time off during the first month.
-Shift starts no earlier than 9:30
Customer Service Skills required
Must have prior experience with a high call volume
Must be comfortable answering phone calls
Microsoft office experience (Excel, Outlook, Word)
Excellent communication both verbal and written
Medical background required
Medical Coding experience to recognize/read the category codes, not to actually code the diagnoses, is preferred
Must be a quick learner and has the ability to work independently, pay attention to detail, and have the ability to produce high quality work
Advance Sourcing Concepts is an EEO employer - M/F/Vets/Disabled