- Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements.
- Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities.
- Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies.
- Review all cases received, to verify if case meets qualifications for appeal review.
- Performs triple check to ensure quality reviews and handling in accordance with policies and procedures.
- Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations.
- Communicate effectively with appeal pharmacists regarding internal and external appeals.
- Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call.
HIPAA