representative i.woonsocket, rhode island (remote)posted today job detailssummary$18.70 - $18.71 per hourtemporaryhigh schoolcategoryoffice and administrative support occupations reference AB_5072893 job details Are you an organized, detail-oriented administrative professional looking for a remote opportunity with a leading organization? We are seeking a dedicated Coverage Determination Representative to support Medicare prior authorization processing! In this key role, you will utilize multiple software applications to review, triage, and process high-volume fax documents and prior authorization case requests. Operating from your quiet home office, you will review incoming documents for accuracy, route files to proper queues, and maintain documentation to meet strict government turnaround times and quality metrics. When complex clinical questions arise, you will seamlessly escalate cases to pharmacists or management staff. If you bring strong data entry skills, an eye for detail, and the ability to work independently in a fast-paced environment, this is a fantastic position to your skills. Work comfortably on a flexible 8-hour schedule between 8:00 AM and 8:00 PM EST (Monday through Friday with rotating weekends) following a comprehensive virtual training period.

salary:

$18.7 - $18.71 per hourshift: Firstwork hours: 8 AM - 5

PMeducation:

High SchoolResponsibilitiesPosition Summary:

Triage incoming fax queues, accurately set up Medicare prior authorization cases, and route files in compliance with government-mandated turnaround times and quality standards.

Key Responsibilities:

Review incoming fax documents accurately and assign cases to appropriate processing queues. Create and update Medicare prior authorization case reviews across multiple database systems. Maintain complete, accurate, and timely documentation of coverage determination and appeal requests. Escalate complex cases or clinical inquiries to coverage pharmacists and management personnel.

Requirements:

High School Diploma or GED required. Proven experience in high-volume data entry and navigating multi-screen computer setups. Dedicated, private home workspace with hardwired high-speed internet (25 Mbps download / 5 Mbps upload minimum). Full availability for mandatory 8-week virtual training (Monday - Friday, 9:00 AM - 5:30 PM EST) with camera enabled.

Preferred:

Background in pharmacy, medical insurance, or healthcare administration. SkillsActive ListeningTelephone EtiquetteEmpathyBasic Software SkillsQualificationsYears of experience: 2 yearsExperience level: ExperiencedRandstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer:

Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.