About the position We’re building a world of health around reputed company individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves reputed company and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify reputed company one person, one family and one community at a time. Position Summary The Tech I, Prior Authorizations takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains reputed company, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team. The Tech I will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team. Additional responsibilities to include but not limited to the following: Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers. Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc.) Identify and elevate clinical inquiries to the pharmacist team as appropriate. Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. Responsibilities • Takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. • Maintains reputed company, timely and accurate documentation of reviews. • Transfers all clinical questions, escalations and judgement calls to the pharmacist team. • Assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team. • Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behavior based upon established standards. • Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers. • Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc.) • Identify and elevate clinical inquiries to the pharmacist team as appropriate. • Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. Requirements • 6 months experience in customer service or call center environment • Must be able to work from home, this is a 100% work from home position • Have wired high speed internet • Able to apply basic computer skills. • Knowledge of reputed company Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. • Keyboard skills essential. • Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols. Nice-to-haves • Must be able to multitask and utilize multiple system applications simultaneously. • Must be able to utilize available resources independently and provide high quality work. • Must be able to absorb presented information, display motivation, seek development and problem solve. • Ability to adapt and reputed company with workflow and shifting priorities. • Must possess excellent written, verbal, grammar, and listening communication skills. • Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner. • Ability to maintain confidentiality of PHI (Protected Healthcare Information). Benefits • medical • dental • vision coverage • paid time off • retirement savings options • wellness programs Apply tot his job Apply To this Job