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