Business Office Manager
About The Position
We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.(sm) This Business Operations Specialist position is required to handle increased workload associated with Prior Authorization system setup. The Prior Authorization system setup includes the loading of letters, updating of tables, loading clinical guidelines, and updating automated decision trees. This role is vital since without it we will risk incomplete guidelines, incomplete or incorrect approval and denial letters loaded for each client for each migration resulting in increased cost to client and decreased member satisfaction.
Requirements
- High School Diploma/GED
- Basic proficiency in MS/Office (Word and Excel) is required
- Research experience in AS400/RxClaim
- Strong writing and documentation skills
- Organizational skills
- Creativity
Nice To Haves
- Bachelor's degree
- Pharmacy Claims experience
- Pharmacy Help Desk or RCR knowledge
- Well-rounded business knowledge including standard prior authorization process
- Well-rounded knowledge of the Pega or Pega Rules Process Commander (PRPC) application
- Knowledge of Center for Medicare Services (CMS) Regulations
- Knowledge of Prior Authorization Case turnaround times (TAT)
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
