Job Description
Job Description: The Rep I, Clinical Services takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team. The Rep I,
7:00 AM
Review the surgical and procedure schedule for the next 48–72 hours. Every case that requires authorization needs to be cleared be…
7:30 AM
Pull the PA worklist. Filter by date of service — cases with the earliest service dates get worked first. High-cost procedures (su…
8:30 AM
Submit PA requests to payers. Each payer has its own portal, its own forms, its own documentation requirements. You know them all…
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