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Tech I - Prior Authorization

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Number of Applicants

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Job Description - Tech I - Prior Authorization

Company Description


Job Description

Job Responsibilities:

  • The Tech I will also assist with other duties such as outbound calls, monitoring / responding to inquiries in mailboxes and other duties as assigned by the leadership team.
  • Effectively manage work volume by handling inbound calls / fax requests utilizing appropriate courteous and professional behaviour 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.
  • This position takes in-coming calls from members, providers, etc. providing professional phone assistance to all callers through the criteria based prior authorization process.
  • Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.

 

Duties:

  • Analyse clinical algorithms and provide decisions regarding PA Requests.
  • Use of online databases and other resources to document appropriate recommendations, clinical decisions and responses.
  • Provide ongoing education on the PA Program to healthcare providers and internal partners.
  • Deliver the highest quality customer service to healthcare providers and internal providers in a high paced dedicated PA program.
  • Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers).
  • Excellent communication skills (oral, written, grammar, listening).
  • PC Windows experience required.
  • Ability to maintain confidentiality.

Shift Times:

  • 8.00 AM TO 4.30 PM

 

Training Information:

  • Training During Day from 9/29 - 10/10 (Monday - Friday)
  • Shift: 6:00AM - 2:30PM

 

Qualifications

 Experience / Education:

  • Minimum three years’ experience required in a customer service position with high volume call centre experience
  • Preferably in healthcare, social services, or a similar service position.
  • Prior Authorization requires a cpht for the role along with a High School Diploma or GED.

Additional Information

All your information will be kept confidential according to EEO guidelines.
Original job Tech I - Prior Authorization posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs.
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About the Company

Sgs Consulting, Inc.

About US: SGS is a New Jersey headquartered end-to-end Professional Services firm servicing a diverse Fortune clientele. SGS is a Equal Opportunity Employer and prides itself as a employee oriented organization that considers an ensemble of all employee satisfaction elements crucial to organizationa...

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