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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