Job Description
Job Description
SUMMARY : Support providers (pharmacists and physicians) with Medicare Part D and / or Commercial pharmacy / specialty drug benefits analysis, drug coverage inquiries and prior authorizations.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Answer telephones in an efficient and timely manner to lend appropriate assistance to providers
2. Triage prior authorization requests under the supervision of a Clinical Pharmacist.
3. Assists in maintaining pharmacy prior authorization criteria used in the adjudication of pharmacy / specialty claims.
4. Analyzing written inquiries which lends to entry and updating of pharmacy authorizations into the claims system.
5. Communicate coverage determination status to physicians and / or members and effectuate such decisions within the authorization tool.
6. Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.
7. Assist with internal control systems and regulations compliance.
8. Perform other related duties as assigned.
Company Description
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries.
In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.
Company Description
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries.
In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.
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