Clinical Coordinator
$47,840–$54,080 year
RemoteUnited States
Job Summary
Create case files and transcribe clinical documentation for coverage determination and appeal requests. Research claim reject messaging for pharmacist review and contact prescriber offices to obtain additional information. Configure authorized outcomes in the adjudication system after pharmacist or client review. Handle inbound phone calls from prescribers and members, respond to routine inquiries, and notify health professionals of decision notifications. Ensure timely and accurate processing while maintaining compliance with established protocols and regulations. Requires Pharmacy Technician Certification and knowledge of CDAG operational processes.
Required Qualifications
- Knowledge in the healthcare, insurance or PBM industry", "Experience in pharmacy benefit management, coverage determination, appeals and grievance (CDAG) operational processes, and regulatory requirements", "Computer and typing proficiency", "Ability to adapt to a dynamic and fast-paced environment", "Motivated individual who is well-organized and able to work with minimal amount of supervision", "High school diploma or GED", "Current and valid Pharmacy Technician Certification, Licensure, or...
Desired Qualifications
- Bachelor's degree
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