The CSI Companies is actively seeking a Remote Customer Service Representative for our client located in the US area.
We are looking for someone who is available to work the following hours:
- Mon- Fri 9am to 5:30pm
The Customer Service Representative will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of the client and in accordance with Medicare Part D CMS Regulations.
- Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
- Assisting with data entry and full service prior authorizations and with outbound and inbound calls.
- Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
- Responsible for research and correction of any issues found in the overall process.
- Phone assistance is required to initiate and/or resolve coverage requests.
- Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
- Must maintain compliance at all times with CMS and department standards.
- Verifiable High School Diploma or GED Required
- Associate's Degree or Bachelor's Degree Preferred
- 2 years experience
- Basic experience in MSWord and MSExcel.