Gainwell Technologies
Pharmacy Prior Authorization Call Center - Remote CT
Gainwell Technologies, Hartford, Connecticut, United States
Overview
Pharmacy Prior Authorization Call Center - Remote CT Summary: The Pharmacy Prior Authorization Call Center Representative will service the Connecticut Medicaid account. This fast-paced position is responsible for answering and providing information/clarification/resolution to prescribers and pharmacies with respect to pharmacy claims and prior authorization questions within established standards. The representative, along with 7 other team members, is required to process all pharmacy prior authorizations received within 2 hours of receipt. On-call and/or working second or third shifts is required on a rotational basis. What You’ll Do
Answer telephones and respond to basic and complex pharmacy questions from providers. Analyze pharmacy claims to respond to provider inquiries. Provide verification and explanation of pharmacy benefits to providers upon inquiry. Document each call inquiry and response provided accurately and with the appropriate amount of detail. Process prior authorization form requests, approved or denied, and document prior authorization records with rationale for approval vs. denial. What We’re Looking For
Knowledge of pharmacy claims and dispensing systems. Ability to work independently within a high-paced, team environment with little direct supervision. Strong multi-tasking, business, and analytical problem-solving skills. Proficiency in Medicaid & Medicare Part D, MS Office Suite, and managing mailboxes in Outlook. Excellent organizational, time management, and communication skills. Ability to maintain confidentiality, comply with HIPAA, and establish positive work relationships. Connecticut Licensed (Active) Pharmacy Technician. Pharmacy Technician Certification – National (preferred). Must reside in the State of Connecticut. What You Should Expect In This Role
Video cameras must be used during all interviews, as well as during the initial week of orientation. Full-time (40 hours a week) Most benefits start on first day of employment Remote (work from home) Eligible for telework with Gainwell; a broadband Internet connection with minimum speed of 24 Mbps download and 8 Mbps upload is recommended. Call center provides support 24 hours per day, 7 days a week, 365 days a year. Call Center is staffed M-F 7:30 AM – 7:30 PM, with rotating Saturday schedule 9 AM – 4 PM. All off hours are covered on an on-call rotation. The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. Gainwell also provides leadership and technical development academies to help build skills and capabilities. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics. Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries: IT Services and IT Consulting Referrals increase your chances of interviewing at Gainwell Technologies by 2x
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Pharmacy Prior Authorization Call Center - Remote CT Summary: The Pharmacy Prior Authorization Call Center Representative will service the Connecticut Medicaid account. This fast-paced position is responsible for answering and providing information/clarification/resolution to prescribers and pharmacies with respect to pharmacy claims and prior authorization questions within established standards. The representative, along with 7 other team members, is required to process all pharmacy prior authorizations received within 2 hours of receipt. On-call and/or working second or third shifts is required on a rotational basis. What You’ll Do
Answer telephones and respond to basic and complex pharmacy questions from providers. Analyze pharmacy claims to respond to provider inquiries. Provide verification and explanation of pharmacy benefits to providers upon inquiry. Document each call inquiry and response provided accurately and with the appropriate amount of detail. Process prior authorization form requests, approved or denied, and document prior authorization records with rationale for approval vs. denial. What We’re Looking For
Knowledge of pharmacy claims and dispensing systems. Ability to work independently within a high-paced, team environment with little direct supervision. Strong multi-tasking, business, and analytical problem-solving skills. Proficiency in Medicaid & Medicare Part D, MS Office Suite, and managing mailboxes in Outlook. Excellent organizational, time management, and communication skills. Ability to maintain confidentiality, comply with HIPAA, and establish positive work relationships. Connecticut Licensed (Active) Pharmacy Technician. Pharmacy Technician Certification – National (preferred). Must reside in the State of Connecticut. What You Should Expect In This Role
Video cameras must be used during all interviews, as well as during the initial week of orientation. Full-time (40 hours a week) Most benefits start on first day of employment Remote (work from home) Eligible for telework with Gainwell; a broadband Internet connection with minimum speed of 24 Mbps download and 8 Mbps upload is recommended. Call center provides support 24 hours per day, 7 days a week, 365 days a year. Call Center is staffed M-F 7:30 AM – 7:30 PM, with rotating Saturday schedule 9 AM – 4 PM. All off hours are covered on an on-call rotation. The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. Gainwell also provides leadership and technical development academies to help build skills and capabilities. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics. Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries: IT Services and IT Consulting Referrals increase your chances of interviewing at Gainwell Technologies by 2x
#J-18808-Ljbffr