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Job Requirements of Coverage Determination Representative II:
-
Employment Type:
Contractor
-
Location:
Work From Home, RI (Remote)
Do you meet the requirements for this job?
Coverage Determination Representative II
Careers Integrated Resources Inc
Work From Home, RI (Remote)
Contractor
Job Title: Coverage Determination Representative II
Location: Remote, RI 27607
Duration: 6 Months+ (Contract With possibility of Extension)
Pay Rate: $20.27/hr. on W2
Important Hiring Information:
Candidate Pre-Submission Questions — Please Confirm:
Position Overview:
Required Experience & Skills:
Education:
Location: Remote, RI 27607
Duration: 6 Months+ (Contract With possibility of Extension)
Pay Rate: $20.27/hr. on W2
Important Hiring Information:
- Safety Sensitive Role
- Start Date: 10/20
- Offer Acceptance By: 9/19
- Last Date to Clear: 10/10
- Offer Extended By: 9/15
- Shift: Rotating 8-hour shifts between 8 AM – 8 PM EST, including rotating weekends
- Training: Mandatory 8 weeks, Mon-Fri, 9 AM – 5:30 PM EST (no planned time off)
- Work Location: 100% Remote, must have a dedicated quiet workspace
- Internet: Wired connection only, minimum 25 Mbps download and 5 Mbps upload (include screenshot of speedtest.net results on resume)
- Technology: Must have experience working with multiple software platforms and dual monitors
- Camera: Must be on camera for all training and meetings
- Resume Requirements: Include state and time zone at the top; internet speed test screenshot; Certification/License NOT required
Candidate Pre-Submission Questions — Please Confirm:
- Do you have any conflicts with the mandatory training schedule (M-F, 9 AM – 5:30 PM EST for 8 weeks)?
- Are you able to work assigned rotating shifts (8 AM – 8 PM EST) including weekends?
- Do you have a private, quiet workspace with a wired internet connection that meets the speed requirements? Please provide your internet provider and speed.
- Are you able to sit and focus without interruptions for the entire shift?
- Do you have experience with data entry and navigating multiple computer applications?
- Do you have a pharmacy or medical background? (Preferred but not required)
- Are you able to work independently in a productivity-driven role?
- Do you consider yourself an engaged and positive team player?
Position Overview:
- Review and complete Medicare prior authorization and drug benefit exception requests per CMS regulations.
- Communicate with providers via phone and professional correspondence to obtain additional info.
- Escalate complex cases to pharmacists and management.
- Comply with strict turnaround times, productivity, and quality standards.
- Maintain confidentiality and professional communication at all times.
Required Experience & Skills:
- Minimum 2 years of relevant experience (prior authorization, clinical review, or pharmacy/medical-related preferred)
- Strong attention to detail and problem-solving skills
- Excellent verbal and written communication
- Proficient computer skills with ability to multitask
- Ability to work under pressure and meet deadlines
- Ability to read and interpret pharmacy/medical terminology and government regulations
Education:
- High School Diploma or GED required
- Associates degree in Business, Accounting, or related field preferred (or equivalent work experience)
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