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Appeals Technician (Temp to Hire)

3 months, 1 week ago
United States
Full-time
Junior
Customer Support
Customer and Technical Support
HIPAA
Apply Now
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017
View All Jobs 30

Description

  • Process incoming first-, second-level, and external appeals with a high level of customer service and productivity.
  • Review cases to determine whether they qualify for appeal review.
  • Maintain quality standards, productivity expectations, and turnaround time requirements for all reviewed cases.
  • Follow internal standard operating procedures and comply with HIPAA guidelines and policies.
  • Perform triple checks to ensure accurate quality reviews and proper handling of cases.
  • Update case types, send appeal acknowledgements, and submit case information to independent review organizations.
  • Communicate with appeal pharmacists regarding internal and external appeals.
  • Make outreach attempts to obtain needed information for case review and document information accurately.
  • Provide complete and accurate information to members and providers by phone and written communication.
  • Perform other related duties as assigned.

Requirements

  • 1+ years of experience as a certified pharmacy technician in a managed care or PBM setting.
  • Active, unrestricted certified pharmacy technician license.
  • Strong organizational skills and detail orientation.
  • Strong oral and written communication skills.
  • Ability to work independently with minimal supervision in a remote, high-volume, metric-driven environment with shifting priorities.
  • Ability to work 12:00pm-9:00pm EST.
  • Experience working with commercial and Medicare appeals (preferred).

Benefits

  • Remote work opportunity in the US.
  • Base salary range of $60,000-$65,000 USD for remote US roles.
  • Base salary range of $78,800-$98,500 USD for New York, NY.
  • Base salary range of $72,000-$90,000 USD for Denver, CO.

Interested in this position?

Apply directly on the company website

Apply Now

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