Prior Authorization System Specialist

Description:The Pay Rate - 26.30$/hr.

The Clinical Operations Consultant fulfills the company purpose of helping people on their path to better health by driving quality execution of administrative support for Prior Authorization. The Clinical Operations Consultant will be a Prior Authorization system Subject Matter Expert providing support for the Prior Authorization/Appeals Operational and Administrative teams. This position works closely with and fosters communications with internal and external departments including clinical development, product owners, CAS liaisons, Account Teams and Prior Authorization Operations to ensure a solid understanding of the programs being processed and implemented.

In order to be successful in this role you will interact and collaborate with internal colleagues to identify opportunities to improve processes and drive efficiencies within the department as well as assist in leading meetings, creation and maintenance of work instructions, training, projects and activities related to PA systems. Consultants also work with a team of system trainers to provide consistent back end user support, assist in documentation and maintenance of user guides presentations and corrective action plans, provide system demos and help guide CAS users through the implementation process for Prior Authorization system tool.

Daily Configuration & Document Management

Configure client setup into the Prior Authorization system ensuring accuracy and completeness

Validate all configurations for compliance and operational standards

Assist in research of general cases submitted to the department

Required Experience:

3+ years of Pharmacy Benefit Management (PBM) prior authorization experience

Preferred Qualifications:

Experience with PA system setup

Experience with MS Excel, Word and PowerPoint

Experience with CAS and/or MedHOK systems

Experience with Prior Auth and Appeals activities

Experience with previous project management.

Strong attention to detail and commitment to high-quality work.

Education:

Bachelor's Degree in any related field

Verifiable High School Diploma, GED, or equivalent

Notes:

Remote

• Schedule: Mon-Fri - 8:30 - 5:00 CST

VIVA USA, Inc. is an IT consulting firm headquartered in Rolling Meadows, IL servicing clients nationwide. We provide services in IT, Telecom, Finance & Accounting, Clerical/Admin and Engineering categories. VIVA USA Inc is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era or disabled veteran.