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RI
Rose International
Coverage Determination & Appeals Representative
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Job Description
Required Education
- High School DiplomaRequired Qualifications/Skills/Experience
- 01 year of Pharmacy, healthcare, or medical background
- 01 year of data entry experience
- Ability to accurately review and triage fax documents
- Ability to perform data entry and route cases to the appropriate queues
- Ability to maintain complete, timely, and accurate documentation
- Ability to maintain knowledge of relevant processes, regulations, and clinical materials
- Ability to work a flexible schedule, including rotating weekends, nights, and holidays Coverage Determination/Appeals Service Representative I Overview
- Responsible for reviewing and triaging data entry-related fax queues with a high level of accuracy
- Reviews each document and places cases in the appropriate queues
- Researches reports and maintains complete, timely, and accurate documentation of Coverage Determination and Appeal requests
- Escalates issues to Coverage Determination/Appeal pharmacists or management staff as needed
- Maintains knowledge of relevant processes, regulations, and clinical materials
- Provides assistance or guidance in partnership with learning and innovation when needed
- Participates in developmental discussions and receives feedback from supervisors Job Duties
- Review fax documents appropriately and forward them to the appropriate queues
- Review each document for accuracy and place the case in the proper queue
- Perform data entry related to Coverage Determination and Appeal fax queues
- Research reports as needed
- Maintain complete, timely, and accurate documentation of Coverage Determination and Appeal requests
- Escalate issues to Coverage Determination/Appeal pharmacists or management staff as needed
- Update and maintain knowledge of relevant processes, regulations, and clinical materials
- Maintain schedule flexibility, including rotations through nights, weekends, and holiday coverage
- Only those lawfully authorized to work in the designated country associated with the position will be considered.
- Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.