Clinical Services Representative

Job Summary

Handling inbound calls from providers, pharmacies, and members, the full-time Clinical Services Representative will assist with the prior authorization process while maintaining accurate documentation and ensuring compliance with HIPAA regulations in a fully remote environment.

Key responsibilities

• Provide courteous assistance through the prior authorization process via inbound calls
• Maintain complete and timely documentation of reviews and clinical interactions
• Transfer clinical questions and escalations to the pharmacist team as needed

Required qualifications

• High School diploma or GED required
• Prior authorization experience preferred
• Knowledge of the healthcare industry is preferred
• Must have a hardwired internet connection with specified speed requirements
• Ability to work on a computer for the duration of the shift