Representative II

*UPDATE*: Please inform Contractors that have an offer the update from management:
As part of the hiring process, we require all new hires to be on camera during meetings. This will include the training portion as well as any meetings with supervisor or team meetings.

This is an attrition RAMP role open to suppliers.

Client bill rate ***
Supplier bill rate ***

Timeline to fill:
Start date: 11/10/2025
Last day to clear: 10/31/2025
Offer to be accepted by: 10/10/2025

Safety Sensitive

***Please DO NOT resubmit candidates that were submitted on previous ramp roles (2023-2024) that were termed for negative reasons or rejected by Hiring Team

On the top of each resume:
**include state & time zone on resume**
*Must provide internet speed test on the resume (INCLUDE SCREEN SHOT) - www.speedtest.net
***Certification/License NOT Required**

Shift: Training Hours are 9a-5:30p EST. Working hours will be a rotating shift between the hours of 8a-8p EST

Please review with candidate, complete, and copy on top of resume
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


1. Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned). All time off needed should be discussed and disclosed during this initial review.
Do you have any conflicts with the training schedule or time off planned during assignment duration?

2. After training, our hours of operation are 8-8 EST M-F with rotating weekend schedules. they must be available for the rotating weekend.
Do you have any conflicts working an assigned 8-hour shift between 8AM 8PM EST and rotating weekends?

3. This is a work from home (WFH) position; must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.
Do you have a separate workspace with no interruptions?
Please include internet speed

4. Must be able to sit and focus on work for the duration of shift.
Are you able to sit and focus with no interruptions for entire shift?

5. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
Do you have data entry experience?

6. Pharmacy or medical background is preferred.
Do you have a Pharmacy or Medical background?

7. Successfully worked independently in a data entry, productivity driven role is preferred
Are you able to work independently?

8. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal
Do you feel you have the engagement and positive attitude to work this assignment?

Opportunity for full-time employment contingent on performance
Virtual interviews with supervisors via Teams or phone.
Hours of operation 8-8 EST M-F with rotating weekend schedules

Position Summary:

The CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Healthcare as the client and in accordance with Medicare Part D CMS Regulations. Must apply information [provided through multiple channels] to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.

Duties:

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.

Experience:

2 years experience. 1.Strong Attention to detail 2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 3.Proficient computer skills and the ability to navigate in a Windows based environment 4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 5.Ability to work in a high pressure, time sensitive environment 6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail 8.Demonstrated sense of urgency with assignments 9.Strong organizational skills 10.Strong telephone skills 11.Ability to read and understand pharmacy/medical terminology 12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required 14.Ability to interpret a variety of work instructions provided through a variety of mediums 15.Ability to anticipate needs and resolve issues with urgency 16.Ability to consistently meet quality and production standards 17.Displays confidence in the ability to learn complex material 18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results

Education:

High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.