Job Snapshot
Location:
Nashville, TN 37212
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Employee Type:
Contractor
Industry:
Healthcare - Health Services
Managed Care
Pharmaceutical
Manages Others:
Not Specified
Job Type:
Health Care
Other
Pharmaceutical
Experience:
Not Specified
Contact Information
Description
Responsible for assisting members, physicians and pharmacies in claims processing. Includes Pharmacy Appeals and Prior Authorization. For the Pharmacy Appeals Unit, may be responsible for handling member and provider calls about denied authorizations and are responsible for reporting performance against CMS guidelines.
Required Skills
Responsible for assisting members, physicians and pharmacists with second level (clinical) pharmacy related issues. Primary focus is on responding to inquiries specifically related to medications (i.e.: process and/or approve requests for Prior Authorization or member reimbursements, assist pharmacies on adjudicating claims over the phone, answer formulary questions regarding therapeutic alternatives, etc.) Troubleshooting benefit and prescription questions with an understanding of prescription rejections and plan parameters. For Part D appeals, responsible for working independently to manage and resolve member grievances, assisting with the management and resolution on appeals, and facilitating submission of appeals to the independent review entity.
Contact a recruiter @ 615-383-3725 or email
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Responsibilities include:
Can prepare, package, and distribute medications prescribed by physicians. Completes paperwork and computer related duties. Assists pharmacists, physicians, nursing and clinical personnel with pharmacy services. Maintains department facilities, equipment, and materials in a condition to promote efficiency, health, comfort, and safety of patients and staff. Checks equipment, supplies and accessories on a regular daily basis. Keeps supplies current and replenished. Processes prescriptions, evaluates for quality and accurate patient identification and side labeling.Qualifications include:
High School diploma or its equivalent certification. Graduate of accredited Pharmacy Technology Program preferred. PTCB or NPTA license preferred. Minimum of one year relevant experience preferred. Current Health Certificate per contract or state specific regulation. Current PPD or Chest X-ray.Maxim employees are our greatest asset. We offer the following benefits:
Medical, Dental, Vision, and Life Insurance 401k Program Competitive Pay Flexible Scheduling Direct Deposit Positive Work Environment and Internal Bonuses Travel Benefits (as applicable) 24 hour on- call serviceSince 1988, Maxim Healthcare Services has become one of the largest employers of clinicians in the nation. At Maxim Staffing Solutions, a division of Maxim Healthcare Services, we're known for our quality of patient care, commitment to employee development and emphasis on customer service. Maxim knows that you deserve great benefits, flexible scheduling and rewarding assignments, so our Healthcare Recruiters will match your skills, experience and schedule in order to find you the best assignments in top medical facilities. Maxim Recruiters are always available to provide you with the assistance you need to get your job done, so call us today; Maxim has a solution for you.
EOE/AAE
Related Keywords:
Pharmacy, pharmacy tech, drug, medication, pharmacy technician, prescription, secretarial, administrative, clerical, clerk, admin., receptionist, assistant, data entry, data-entry, front-desk, secretary, front desk
For more information about our job opportunities, please visit our website.
www.maximstaffing.com
