CCS Medical

Pre-Authorization Representative

Job Location US-VA-Roanoke
ID
2018-2174
Category
Administrative/Clerical
Position Status
Regular Full-Time
Position Schedule
Monday-Friday
Shift
9:00 - 6:00

Overview

Oversees all processes and procedures for departmental employees including training for new employees, on-going education of intermediate employees, assistance in coordination of work process flows, and informational support.

Responsibilities

Essential Duties:

 

  • Distributes assigned tasks to the work group
  • Monitors progress of newly trained personnel, reports progress to department Supervisor
  • Performs essential duties of the base position including adjudicating PBM claims, working insurance rejections, obtaining Rx’s
  • Assists supervisor/manager with elevated employee questions
  • Intermediate employee coaching/training
  • Leads by example to promote professionalism in all areas
  • Assists supervisor/manager with employee training and development initiatives
  • Demonstrates accountability and responsiveness to the needs of clients
  • Monitors internal errors
  • Maintains a high degree of confidentiality at all times due to access to sensitive information
  • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
  • Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
  • Abides by all regulations, policies, procedures and standards
  •  

Performance Responsibilities:

 

  • Exercises appropriate cost control measures
  • Maintains positive internal and external customer service relationships
  • Maintains open lines of communication
  • Plans and organizes work effectively and ensures its completion
  • Meets all productivity requirements
  • Demonstrates team behavior and promotes a team-oriented environment
  • Actively participates in Continuous Quality Improvement
  • Represents the organization professionally at all times

Qualifications

  • High School Diploma or (GED) equivalent, 3 years of related experience, or equivalent combination of education and experience
  • Minimum of 6 months CCS Medical experience

 

  • Demonstrated ability to interpret documents such as Medicare/Medicaid regulation and procedural manuals
  • Proficient with various Microsoft Office software such as Word, Excel and PowerPoint
  • Strong communication and organizational skills are essential
  • Demonstrated ability to accurately perform data entry and pay close attention to detail

Equal Opportunity Employer/Veterans/Disabled

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