Remote Clinical Coordinator for Coverage Determinations

SlateRx; Las Vegas (NV); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

401k

Paid Time Off

Job summary

SlateRx seeks a Clinical Coordinator to support the clinical functions of coverage determinations and appeals in our remote team. You will help ensure efficiency, accuracy, and timeliness in reviewing requests, creating case files, and transcribing clinical documentation for pharmacist review.

In this role you will contact prescriber offices, respond to inquiries from members and providers, and maintain strict compliance with governing protocols while coordinating with physicians, members, and

Qualifications

• Knowledge in the healthcare, insurance or PBM industry.
• Experience with CDAG processes and regulatory requirements.
• Computer and typing proficiency.
• Ability to adapt to a dynamic and fast-paced environment.
• Well-organized and able to work with minimal supervision.

Responsibilities

• As a Clinical Coordinator, create case files and transcribe clinical documentation for coverage determination and appeal requests.
• Research claim reject messaging related to coverage determinations and appeal requests for pharmacist review.
• Contact prescriber offices to obtain additional information.
• Configure coverage determination and appeal outcomes in the adjudication system after pharmacist/client review.
• Handle inbound calls from prescribers and members regarding coverage determinations.
• Respond to routine inquiries regarding coverage determinations with members, prescribers, and pharmacies.
• Notify physicians, members, and health professionals of decision outcomes.
• Ensure timely and accurate processing of requests.
• Maintain compliance with protocols and regulations from governing bodies.
• Perform miscellaneous duties as assigned.

Skills

Healthcare industry knowledge

PBM/CDAG experience

Typing proficiency

Fast-paced environment

Organized work style

Education

High school diploma or GED

Bachelor’s degree preferred

Job description

SlateRx seeks a Clinical Coordinator to support the clinical functions of coverage determinations and appeals in our remote team. You will help ensure efficiency, accuracy, and timeliness in reviewing requests, creating case files, and transcribing clinical documentation for pharmacist review.

In this role you will contact prescriber offices, respond to inquiries from members and providers, and maintain strict compliance with governing protocols while coordinating with physicians, members, and