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Utilization Manager, Appeals Technician
Location
New York
Posted
3 days ago
Salary
$60K - $65K / year
Seniority
Junior
Job Description
Utilization Manager, Appeals Technician
Capital Rx
• 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
Job Requirements
- 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
Benefits
- Health insurance
- Retirement plans
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