Supports documentation compliance by recording patient interactions, updating case notes in pharmacy systems, and maintaining privacy requirements.
Processes prior authorization requests by collecting clinical documentation, completing payer-specific forms using templates, submitting requests, and tracking status.
Verifies insurance coverage by reviewing patient insurance cards, checking formulary information, and documenting coverage details.
Supports financial assistance enrollment by collecting patient eligibility information, completing manufacturer copay applications, and submitting paperwork to program administrators.
Coordinates specialty pharmacy referrals by processing forms, verifying insurance benefits, scheduling patient calls, and liaising with specialty pharmacy teams.
Requirements
High School Diploma/GED or equivalent
Associate's degree in healthcare administration, life sciences, pharmacy technology, or a related field
Responsible for interpreting and entering moderately complex prescriptions, processing prior authorizations, and troubleshooting adjudication issues for a pharmacy within a virtual hybrid environment.
Responsibilities
Verifies member information and inputs data for pharmacists
Educates members on pharmacy rules and medication resources
Processes prior authorization requests and ensures Medicare compliance
Provides resolution to grievances and appeals
Responds to inquiries from physicians, sales team, and members
Provides regulatory, payer, and operational support at the office level, ensuring survey readiness, Medicaid and payer coordination, insurance verification, prior authorization, audit response, medical records retrieval, and office administrative operations.
Compensation
The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives.
Responsibilities
Serve as local point of contact for CMS, Medicaid, accreditation, and payer surveys
Maintain continuous survey readiness and compliance
Coordinate mock surveys, compliance audits, and readiness assessments
Maintain regulatory documentation and support office leadership in compliance monitoring
Monitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory
Requirements
High school diploma or equivalent
Associate or bachelor's degree in healthcare administration, Business Administration, Public Health, Regulatory Affairs, or related field
Serve as the office-level regulatory, payer, and operational support lead focusing on survey readiness, Medicaid/payer coordination, and administrative operations.
Compensation
The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses andor incentives
Responsibilities
Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys.
Maintain continuous survey readiness and compliance with regulatory, licensing, accreditation, and company requirements.
Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions.
Maintain regulatory documentation and support office leadership in compliance monitoring.
Monitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory.
Requirements
Associate or bachelor's degree in healthcare administration
The role serves as the office-level regulatory, payer, and operational support lead responsible for survey readiness, Medicaid and payer coordination, and providing operational support with insurance verification, prior authorization, audit response coordination, medical records retrieval, and office administrative operations.
Compensation
The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives.
Responsibilities
Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys.
Maintain continuous survey readiness and compliance with regulatory, licensing, accreditation, and company requirements.
Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions.
Maintain regulatory documentation and support office leadership in compliance monitoring.
Monitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory.
Serve as the office-level regulatory, payer, and operational support lead responsible for survey readiness, Medicaid/payer coordination, and administrative operations.
Compensation
The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives.
Responsibilities
Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys.
Maintain continuous survey readiness and compliance with regulatory, licensing, accreditation, and company requirements.
Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions.
Maintain regulatory documentation and support office leadership in compliance monitoring.
Monitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory.
The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives.
Responsibilities
Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys
Maintain continuous survey readiness and compliance with regulatory, licensing, accreditation, and company requirements
Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions
Maintain regulatory documentation and support office leadership in compliance monitoring
Monitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory
Requirements
Associate or bachelor's degree in healthcare administration, Business Administration, Public Health, Regulatory Affairs, or related field
The starting hourly rate for this position is $24.07. Hired candidates may be eligible to receive additional compensation for applicable experience and may also be eligible for bonuses and/or incentives.
Responsibilities
Serve as the local point of contact for CMS, Medicaid, accreditation, and payer surveys
Maintain continuous survey readiness and compliance with regulatory, licensing, accreditation, and company requirements
Coordinate mock surveys, compliance audits, and readiness assessments; communicate findings and corrective actions
Maintain regulatory documentation and support office leadership in compliance monitoring
Monitor and interpret Medicaid regulations, payer policies, and reimbursement requirements within assigned territory
Requirements
Associate or bachelor's degree in healthcare administration, Business Administration, Public Health, Regulatory Affairs, or related field
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