Job Description

In this pivotal role, CSRs respond primarily to phone, also fax and online inquiries from health care professionals to assist them through the medication prior authorization process.

Initial screening of requests based on guidance given by online prior authorization tools.

Approves prior authorization requests if the data collected meets the approval specifications.

Refers prior authorization requests that do not meet the approval specifications to a Pharmacist for clinical review. Independently responds to contacts ranging from routine to moderate complexity.

May seek assistance with health care professional services issue of substantial complexity.

Performs research to respond to inquiries and interprets policy provisions to determine most effective response using established departmental procedures, HIPAA regulations, and corporate policies.