Prior Authorization / SME
- Schedule:
- Monday - Friday, 8:30 AM - 5:00 PM Central Time.
- Daily Configuration & Document Management:
- Configure client setup into the Prior Authorization system, ensuring accuracy and completeness.
- Validate all configurations for compliance and operational standards.
- Assist in research of general cases submitted to the department.
- Duties:
- The Clinical Services Consultant fulfills the company purpose of helping people on their path to better health by driving quality execution of administrative support for Prior Authorization.
- The Clinical Services Consultant will be a Prior Authorization system Subject Matter Expert, providing support for the Prior Authorization/Appeals Operational and Administrative teams.
- This position works closely with and fosters communications with internal and external departments, including clinical development, product owners, CAS liaisons, Account Teams, and Prior Authorization Operations to ensure a solid understanding of the programs being processed and implemented.
- In order to be successful in this role, you will interact and collaborate with internal colleagues to identify opportunities to improve processes and drive efficiencies within the department.
- You will assist in leading meetings, creation and maintenance of work instructions, training, projects, and activities related to PA systems.
- Consultants also work with a team of system trainers to provide consistent back-end user support.
- Assist in documentation and maintenance of user guides, presentations, and corrective action plans.
- Provide system demos and help guide CAS users through the implementation process for the Prior Authorization system tool.
- Experience:Required Qualifications:
- 3+ years of Pharmacy Benefit Management (PBM) prior authorization experience.
- Preferred Qualifications:
- Experience with PA system setup.
- Experience with MS Excel, Word, and PowerPoint.
- Experience with CAS and/or MedHOK systems.
- Experience with Prior Auth and Appeals activities.
- Experience with previous project management.
- Education:
- Bachelor's Degree in any related field.
Location: Remote - USA
- Skills required for this job:
- Data analysis
- Healthcare
- Microsoft PowerPoint
- Microsoft Word
- Pharmacy Benefit Management
- Prior authorization system
- Project management
- Regulatory compliance
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