BM & PS RX ANALYST II

at  ALLCARE HEALTH

WE ARE SEEKING QUALIFIED CANDIDATES TO JOIN OUR TEAM!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

SUMMARY

This position is responsible for processing and conducting the initial review of referrals and prior authorizations according to applicable government and/or health plan policies by performing the following duties.

EDUCATION & EXPERIENCE

• High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
• Knowledge of or familiarity with ICD and/or CPT/HCPC coding is required.

ESSENTIAL DUTIES

1. Processes service determination requests for one service type.
2. Conducts outreach for supporting documentation.
3. Provides oral and written member notifications on service determinations.
4. Monitors compliance on service determinations.

ON CALL RESPONSIBILITIES

Analysts are on-call positions. Complies with mandatory scheduled check-in days/times.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

• The employee must be able to work onsite as needed.
• The employee must be able to work from a home office as needed