161260 - Coverage Determination Representative I – Hybrid– $17.50 / hr

Job Title : Coverage Determination Representative I – Hybrid (San Antonio, TX) – $17.50 / hr

Location : San Antonio, TX (Hybrid – 3 days / week in office)

Do you have the following skills, experience and drive to succeed in this role Find out below.

Pay : $17.50 / hr

Schedule : Full-time | Monday–Friday, 8AM–8PM EST (rotating weekends)

Training : 8 weeks, 9AM–5 : 30PM EST (attendance required)

Start Date : November 10, 2025

About the Role

Join the client’s company as a Coverage Determination Representative I (Medicare Prior Authorization) , supporting Medicare Prior Authorization case reviews. This is a great opportunity for detail-oriented individuals who thrive in a productivity-driven environment. You’ll work both independently and collaboratively, ensuring cases are processed accurately and on time.

Coverage Determination Representative I (Medicare Prior Authorization) Key Responsibilities

• Create and manage Medicare Prior Authorization case reviews using multiple systems.
• Meet or exceed turnaround, productivity, and quality standards.
• Review faxed documentation and route to appropriate queues.
• Maintain accurate and timely case documentation.
• Escalate issues to pharmacists or management as needed.
• Stay current with policies, procedures, and medical guidelines.

Remote working / work at home options are available for this role.