HCS Data Rx Specialist II

Job Description

Job Description

JOIN UHA’S TEAM

We focus on your health and pay 100% for your family's medical insurance and provide 20 days of paid personal time off during your first year!

HCS Data Rx Specialist II

Department : Health Care Services

FLSA Status : Full Time, Non-Exempt

Salary Level : 3

Position Summary :

This position will conduct administrative functions for the Health Care Services Data & Pharmaceutical team. When needed, provide general administrative support to the other Health Care Services department teams, i.e. : Management, Clinical and Administrative. Always maintain and follow department policy and procedures while also ensuring URAC standards, criteria and guidelines are met.

Essential Duties & Responsibilities :

• Handle inbound and outbound telephone calls related to pharmaceuticals (prior authorization inquiries, CEM, vacation, PLA inquiries, pharmacy inquiries)
• Process incoming drug request overrides (via phone or fax) by determining validity of the request, if not sent to the PBM / CCUM
• Assist with non-clinical review of Rx prior authorizations, data entry, and proper process for clinical review.
• Utilize and navigate various database systems, both internal and external
• Request additional clinical notes as needed.
• Retrieve messages from the telephone answer service and add messages to the Voicemail system.
• Discuss inquiries with other staff and / or departments to resolve any issues.
• Retrieve and file electronic documents and various faxes.
• Assign to the appropriate staff, prior authorization file and / or designated folder.
• Open, scan and distribute mail.
• Coordinate meetings and conference calls by confirming availability of all participants as well as availability of conference room or offsite facility.
• Electronic filing of completed member records and / or any other miscellaneous documentation.
• Update the system as necessary or return the file to the proper HCS staff to make corrections.
• Assist with the creation, updating and revising of Health Care Services educational materials as necessary, including PowerPoints or other materials.
• Accurately maintain and update department policies and procedures, performing Quality Control (QC) reviews as necessary
• Perform other duties and / or projects as assigned by the HCS Data / Rx Supervisor or management.
• Request for additional duties or to be crossed trained in other duties when workload permits.
• This Position prohibits any activity that requires interpretation of clinical information to Customers, including the choosing of a set of criteria to use for handling a request for healthcare services or treatment.

Required Education and Experience :

The individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Preferred and Advanced Qualifications :

Physical Demands / Working Conditions :

The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.

This position is eligible to work from home subject to manager’s approval

Competitive compensation & excellent benefits offered

Visit our website at https : / / uhahealth.com / page / career -opportunities to apply and for details about vacant positions.

An Equal Opportunity Employer