Appeals Technician
J
Judi HealthHealth Technology
Location: Remote, 12pm-9pm ESTContractMiddle
Salary60,000 - 65,000 USD per year
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Job Details
- Experience
- 1 + years
- Required Skills
- HIPAA
Requirements
- 1+ years of experience working as a certified pharmacy technician in a managed care or PBM setting.
- Active, unrestricted PTCB or NHA Certified Pharmacy Technician certification.
- Ability to work 12pm-9pm EST hours.
- Strong oral and written communication skills.
- Excellent organization and detail orientation.
- Ability to work independently with minimal supervision in a high-volume, metric-driven environment.
- Ability to stay productive with shifting priorities.
- Adherence to HIPAA guidelines and policies.
Responsibilities
- Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements.
- Review all cases received to verify if they meet qualifications for appeal review.
- Perform triple check to ensure quality reviews and handling in accordance with policies and procedures.
- Update case types, send appeal acknowledgements, and submit 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.
- Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers.
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