Description: Apex Systems has an exciting opportunity for you as a coverage determination and appeals technician. Please email resumes to email@example.com if you are interested.
Solon, Ohio 44139
As a technician, you need to assure complete, timely and accurate documentation of all coverage determinations in conjunction with Medicare guidelines. As a pharmacy technician in this role you will need to possess the ability to interact with a diverse patient and physician base in a professional manner and to work in a team environment. This role requires availability to work a steady schedule with shifts normally between 9am -7:30pm and an every 4th weekend rotation..
-Proficient in Windows applications (Word and Excel)
-Proficient use of keyboard, mouse and ability to navigate 2 monitors
* 6+ months of healthcare experience
* Problem solving skills, analytical ability
* Strong written communication and interpersonal skills
* Detail oriented and excellent organizational skills
* High School Diploma or GED required
If the person were to be hired the pay rate would be $13.00
Ohio pharmacy tech license is not required.
Qualifications: Qualification Rating
Position Summary: The Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of health care plans and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through evenings, weekends and holiday coverage.
Duties: Customer service focus. Basic experience in MSWord and MSExcel. Familiar with medical terminology is helpful but not required. Ability to read and interpret medical orders/charts. The position also requires an extensive amount of data entry work.
Experience: 1.Strong Attention to detail 2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 3.Proficient computer skills and the ability to navigate in a Windows based environment 4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 5.Ability to work in a high pressure, time sensitive environment 6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail 8.Demonstrated sense of urgency with assignments 9.Strong organizational skills 10.Strong telephone skills 11.Ability to read and understand pharmacy/medical terminology 12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required 14.Ability to interpret a variety of work instructions provided through a variety of mediums 15.Ability to anticipate needs and resolve issues with urgency 16.Ability to consistently meet quality and production standards 17.Displays confidence in the ability to learn complex material 18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results
Apex is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178