31 applicants
This job has closed.
LanceSoft, Inc. · 2 days ago
Provider Relations Representative (Prior Authorization)
United States
Full-time
Remote
Entry Level
$16/hr - $18/hr
Wonder how qualified you are to the job?
Maximize your interview chancesInformation Technology
Hiring Manager
Nirmala Kumari Singh
Insider Connection @LanceSoft, Inc.
Responsibilities
Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.
Ability to work in a fast-paced environment, handling both inbound and outbound calls.
Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. Good communication skills are essential, both internal and external.
Knowledge of Medicare benefits, enrollments and LIS assistance.
Plans and organizes work assignments, set priorities and completes work with a minimum of supervision.
Communicates effectively and professionally with program partners to assure the best possible service for patients and partners. Other duties as assigned.
Take 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 judgment calls to the pharmacist team.
Assist with other duties as needed including outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes, and other duties as assigned by the leadership team.
Customer service focus. Basic experience in MSWord and MSExcel.
Familiar with medical terminology and knowledge of medical coding.
Ability to read and interpret billing documents.
The position also requires an extensive amount of data entry work.
Qualification
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
Healthcare Experience Required for this role
Must have call center experience
Healthcare Experience - Medicare Experience
Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing
Ability to work in a fast-paced environment, handling both inbound and outbound calls
Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines
Good communication skills are essential, both internal and external
Knowledge of Medicare benefits, enrollments and LIS assistance
Plans and organizes work assignments, set priorities and completes work with a minimum of supervision
Communicates effectively and professionally with program partners to assure the best possible service for patients and partners
High School Diploma or GED required
Assigned shifts vary from 7AM-8PM CT
Basic experience in MSWord and MSExcel
Familiar with medical terminology and knowledge of medical coding
Ability to read and interpret billing documents
Extensive amount of data entry work
Preferred
Associates degree in Business, Accounting or equivalent work experience
Benefits
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
Company
LanceSoft, Inc.
Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization, and a pioneer in providing premium end-to-end Global Workforce Solutions and IT Services to diverse clients across various domains.
Founded in 2000
1,001-5,000 employees
H1B Sponsorship
LanceSoft, Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Trends of Total Sponsorships
2023 (20)
2022 (22)
2021 (46)
2020 (69)
Funding
Current Stage
Late StageLeadership Team
Ram Karuppusamy
Chairman & CEO
Simon Dealy
Chief Financial Officer
Company data provided by crunchbase
