Clinical Coordinator

Valid8 Financial, Inc.; Las Vegas (NV); On-site; USD 45,000 - 65,000; Full time

Job summary

Valid8 Financial, Inc. is looking for a Clinical Coordinator to manage clinical functions related to coverage determinations and appeals. This role demands efficiency and accuracy in processing requests and necessitates a current Pharmacy Technician Certification. The position is ideal for individuals with experience in pharmacy benefit management, looking to contribute in a dynamic and supportive healthcare environment.

The successful candidate will create case files, handle inquiries, and ensure compliance with established protocols.

Qualifications

• Strong knowledge in healthcare, insurance, or PBM industry.
• Proficient in pharmacy benefit management and appeals processes.
• Required skills in computer use and typing.

Responsibilities

• Create case files for coverage determination and appeal requests.
• Research claim reject messaging for reviews.
• Contact prescriber offices for additional information.
• Maintain compliance with regulatory protocols.
• Respond to inquiries about coverage determinations.

Skills

Knowledge in the healthcare, insurance or PBM industry

Experience in pharmacy benefit management

Computer and typing proficiency

Adaptability to a dynamic environment

Organized and able to work with minimal supervision

Education

High school diploma or GED

Bachelor’s degree

Job description

Founded by industry pioneers, SlateRx provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry’s only PBXTM, SlateRx is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members.

Job Overview

As a Clinical Coordinator, you will be responsible for supporting the clinical functions of coverage determinations and appeals in accordance with the policies and practices of SlateRx, LLC. This position will be responsible for ensuring efficiency, accuracy, and timeliness in reviewing coverage determinations and appeals.

Responsibilities

• Create case files and transcribe clinical documentation for coverage determination and appeal requests.
• Research claim reject messaging associated with coverage determination and appeal requests for pharmacist review.
• Contact prescriber offices to obtain additional information.
• Configure authorized coverage determination and appeal outcomes in the adjudication system after completion of review and decision by the pharmacist or client.
• Handle inbound phone calls from prescribers and members regarding coverage determinations.
• Respond to routine inquiries and correspondence regarding coverage determinations and appeals with members, prescribers, and pharmacies as applicable.
• Notify physicians, members, and other health professionals as applicable, of coverage determination request decisions.
• Ensure timely and accurate processing of requests.
• Maintain compliance with established protocols and regulations from governing and accrediting agencies.
• Perform miscellaneous job-related duties as assigned.

Qualifications

• Knowledge in the healthcare, insurance or PBM industry.
• Experience in pharmacy benefit management, coverage determination, appeals and grievance (CDAG) operational processes, and regulatory requirements.
• Computer and typing proficiency.
• Ability to adapt to a dynamic and fast-paced environment.
• Motivated individual who is well-organized and able to work with minimal amount of supervision.

Education

High school diploma or GED required; Bachelor’s degree strongly preferred.

License Requirement

Current and valid Pharmacy Technician Certification, Licensure, or Registration is required.