Clinical Coordinator, Coverage Determinations & Appeals

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

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.