Appeals Technician (temp-to-hire)

Capital Rx Inc.; New York (NY); Remote; USD 60,000 - 65,000; Full time

Job summary

Judi Health, a health technology company, is seeking a detail-oriented Pharmacy Technician for a remote role to support first through external appeals across Commercial, Exchange and Medicare lines.

You will ensure high-quality customer service while maximizing productivity, adhere to HIPAA, and collaborate with pharmacists and medical directors to submit timely appeals for review.

Qualifications

• Certified pharmacy technician with active, unrestricted certification.
• 1+ year in managed care or PBM setting required.
• Excellent organization and attention to detail.
• Strong oral and written communication skills.
• Ability to work independently in remote, high-volume environment.
• Ability to work 12pm-9pm EST.

Responsibilities

• Handle incoming requests for first, second level and external appeals.
• Coordinate with appeals team for Commercial, Exchange and Medicare lines.
• Maintain quality and productivity while meeting turnaround times.
• Follow SOPs and HIPAA guidelines.
• Verify case qualifications for appeal review.
• Update case types and submit information to independent review organizations.
• Communicate with appeal pharmacists regarding internal and external appeals.
• Obtain necessary information by phone and record data accurately.
• Provide accurate information to members and providers.
• Perform other related duties as assigned.

Skills

Pharmacy technician

PTCB/NHA certification

Detail oriented

Communication skills

Independent worker

Remote work

Job description

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Position Summary:

Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity. Work with appeals team for multiple lines of business such as Commercial, Exchange and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors.

Position Responsibilities:

• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements.
• Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies.
• Review all cases received, to verify if case meets qualifications for appeal review.
• Performs triple check to ensure quality reviews and handling in accordance with policies and procedures.
• Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations.
• Communicate effectively with appeal pharmacists regarding internal and external appeals.
• Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call.
• Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers.
• Performs all other related duties as assigned

Minimum Qualifications:

• 1 + year of experience working as a certified pharmacy technician in a managed care or PBM setting required.
• Active, unrestricted PTCB or NHA Certified Pharmacy Technician certification required.
• Excellent organization details and strong detail orientation.
• Strong oral and written communication skills.
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities.
• Ability to work 12pm-9pm EST hours

Preferred Qualifications:

• Experience working with commercial and medicare appeals preferred

Remote, US Salary Range$60,000—$65,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found athttps://www.judi.health/legal/privacy-policy.