Remote Coverage Determination Representative 161259

Job Description

Job Description

A Line Staffing is now hiring Coverage Determination Representative. Candidates can be located anywhere in the US. The Coverage Determination Representative will work closely with providers to process prior authorization (PA) and drug benefit exception requests on behalf of Aetna, in accordance with Medicare Part D CMS Regulations. This is a full-time position with career growth potential.

If you are interested in this Coverage Determination Representative position, please apply to this posting or call 586 710 7946!

Compensation

• Pay: 20.28 per hour

• Benefits available to full-time employees after 90 days of employment

• 401(k) with company match available after 1 year of service on eligibility dates

Highlights

• Schedule: 8-hour shifts, Monday–Friday, 8:00 AM – 8:00 PM EST, rotating weekends

• Training: Monday–Friday, 9:00 AM – 5:30 PM EST for 3 weeks

• Location: Fully remote (never onsite)

Duties

• Provide excellent customer service in a high-pressure environment

• Perform extensive data entry and maintain accurate records

• Utilize MS Word and MS Excel for documentation and reporting

• Apply knowledge of medical terminology and medical coding

• Read and interpret billing documents, business correspondence, and technical procedures

• Conduct provider outreach by phone to obtain required information for coverage requests

• Research and resolve issues in the prior authorization process

• Escalate cases to pharmacists or management as needed

• Maintain compliance with CMS and department standards

Experience

• 2 years of relevant experience required

• Strong attention to detail and organizational skills

• Excellent verbal and written communication, with ability to maintain patient confidentiality

• Proficient in computer navigation within a Windows-based environment

• Adaptable to change and able to work in dynamic, time-sensitive environments

• Strong problem-solving skills with demonstrated urgency in completing assignments

• Ability to consistently meet quality and production standards

• Ability to interpret work instructions from multiple mediums

• Strong telephone skills and professional communication style

• Intellectual curiosity and willingness to learn complex material

Education

• High School Diploma or GED required

• Associate’s degree in Business, Accounting, or equivalent work experience preferred

If you think this CD Representative II position is a good fit for you, please apply to this posting or call 586 710 7946!

Code: 161259