Utilization Manager, Appeals Technician

🕒 Maio 22

🗽 New York – Remoto

🗽 New York – Remote

💵 $60.000 - $65.000 / ano

⏰ Tempo Integral

🟢 Júnior

👔 Gerente

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Capital Rx

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2017

⚕️ Seguro de Saúde

💳 Fintech

🤖 Inteligência Artificial

Healthcare Insurance • Fintech • Artificial Intelligence

Capital Rx é a healthtech que mais cresce nos Estados Unidos, dedicada a transformar os modelos de precificação de medicamentos e de cuidado ao paciente. Fundada em 2017, oferece serviços inovadores de gestão de benefícios farmacêuticos (PBM), incluindo benefícios de farmácia personalizáveis para grandes empregadores e uma plataforma de navegação de cuidados com IA. A Capital Rx foca em entregar soluções custo-efetivas e eficiências operacionais aos clientes, garantindo transparência e cuidado de qualidade para os pacientes.

Descrição

• Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity. • Work with appeals team for multiple lines of business such as Commercial, Exchange and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors. • Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements. • Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities. • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies. • Review all cases received, to verify if case meets qualifications for appeal review. • Performs triple check to ensure quality reviews and handling in accordance with policies and procedures. • Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations. • Communicate effectively with appeal pharmacists regarding internal and external appeals. • Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call. • Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers. • Performs all other related duties as assigned

🎯 Requisitos

• 1 + years’ experience working as a certified pharmacy technician in a managed care or PBM setting required. • Active, unrestricted certified pharmacist technician license required. • Excellent organization details and strong detail orientation. • Strong oral and written communication skills. • Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities. • Ability to work 12pm-9pm EST hours

🏖️ Benefícios

• Health insurance • Retirement plans