Coverage Determination Representative II

Job Title: Coverage Determination Representative II
Location: Remote, RI 02895
Duration: 6+ Months (Possible Extension)

Pay Rate: $20.30/hr. on W2
 
UPDATE FOR CONTRACTORS WITH AN OFFER:
As part of the hiring process, all new hires are required to be on camera during meetings. This includes the training portion as well as any meetings with supervisors or team meetings.
 
Resume Requirements:

• Include state & time zone on resume.
• Must provide internet speed test on the resume (INCLUDE SCREENSHOT) – www.speedtest.net
• Certification/License NOT Required.

 
Shift Details:

• Training Hours: 9:00 AM – 5:30 PM EST
• Working Hours: Rotating shift between 8:00 AM – 8:00 PM EST

 
Position Summary:
In this role, Coverage Determination Representative II, contractors will be responsible for:

• Utilizing multiple software systems to complete Medicare Prior Authorization case reviews.
• Meeting or exceeding government-mandated timelines.
• Complying with turnaround time, productivity, and quality standards.
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.

 
Duties:

• Utilizing multiple software systems to complete Medicare Prior Authorization case reviews.
• Meeting or exceeding government-mandated timelines.
• Complying with turnaround time, productivity, and quality standards.
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.

 
Interview Questions & Requirements:

• Attendance:
  Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available Monday–Friday, 9:00 AM – 5:30 PM EST (no vacation time planned).
  Do you have any conflicts with the training schedule or time off planned during assignment duration?
• Post-Training Schedule:
  After training, hours of operation are 8:00 AM – 8:00 PM EST, Monday–Friday, with rotating weekend schedules.
  Do you have any conflicts working an assigned 8-hour shift between 8:00 AM – 8:00 PM EST and rotating weekends?
• Work from Home Requirements:
  This is a remote position; must have a dedicated, quiet workspace and wired internet meeting 25 Mbps minimum download and 5 Mbps minimum upload speed.
  Previous WFH experience preferred.
  Do you have a separate workspace with no interruptions? Please include internet speed.
• Focus and Endurance:
  Must be able to sit and focus on work for the duration of the shift.
  Are you able to sit and focus with no interruptions for entire shift?
• Data Entry Experience:
  Data entry and navigating multiple computer applications while utilizing two screens is the primary function of this job (possible outbound calls may be needed).
  Do you have data entry experience?
• Background:
  Pharmacy or medical background is preferred.
  Do you have a Pharmacy or Medical background?
• Independence:
  Must have successfully worked independently in a data entry, productivity-driven role.
  Are you able to work independently?
• Team Engagement:
  The company values an engaged and positive team.
  Do you feel you have the engagement and positive attitude to work this assignment?

 
Additional Details:

• Opportunity for full-time employment contingent on performance.
• Virtual interviews with supervisors via Teams or phone.
• Hours of operation: 8:00 AM – 8:00 PM EST, Monday–Friday, with rotating weekend schedules.

 
Experience:
2 years of experience required.
Skills & Abilities:

• Strong attention to detail.
• Excellent verbal and written communication and interpersonal skills with ability to maintain patient confidentiality.
• Proficient computer skills and ability to navigate in a Windows-based environment.
• Ability to follow directions and adapt in a dynamic work environment; flexible and open to change.
• Ability to work in a high-pressure, time-sensitive environment.
• Project a professional business image through phone interaction and internal communications.
• Demonstrated problem-solving ability and attention to detail.
• Demonstrated sense of urgency with assignments.
• Strong organizational skills.
• Strong telephone skills.
• Ability to read and understand pharmacy/medical terminology.
• Ability to read, analyze, and interpret general business correspondence, technical procedures, and governmental regulations.
• Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations.
• Ability to perform basic mathematical calculations (may be required).
• Ability to interpret a variety of work instructions provided through different mediums.
• Ability to anticipate needs and resolve issues with urgency.
• Ability to consistently meet quality and production standards.
• Displays confidence in ability to learn complex material.
• Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results.

 
Education:

• High School Diploma or GED required.
• Associate’s degree in Business, Accounting, or equivalent work experience preferred.