Job Summary
This role is essential for facilitating daily workflows related to coverage determinations and appeals. The position involves processing cases efficiently, overseeing queues, ensuring accuracy and compliance in work, and addressing escalated issues as they arise. The individual will play a crucial role in maintaining comprehensive workflow documentation and executing effective communication related to procedural changes.
Responsibilities
- Process and manage cases related to coverage determinations and appeals.
- Monitor queues to ensure timely handling of workflows.
- Review work to maintain accuracy and adherence to compliance standards.
- Assist in resolving escalated inquiries or issues.
- Maintain up-to-date workflow documentation and communicate any procedural updates.
- Respond to inquiries from stakeholders effectively.
- Identify gaps in processes and recommend improvements.
Qualifications
- Knowledge of pharmacy benefit management and CDAG operations.
- Understanding of relevant regulations and compliance standards.
- Strong skills in data entry, documentation, analysis, organization, and communication.
- A high school diploma or GED is a minimum requirement.
- A bachelor’s degree is highly preferred.
- Candidates should possess current pharmacy technician certification, licensure, or registration.
- Alternatively, at least four years of relevant industry experience is acceptable.
