Coverage Determination & Appeals Representative

Overview: Responsible for reviewing and triaging data entry-related fax queues with a high level of accuracy Reviews each document and places cases in the appropriate queues Researches reports and maintains complete, timely, and accurate documentation of Coverage Determination and Appeal requests Escalates issues to Coverage Determination/Appeal pharmacists or management staff as needed Maintains knowledge of relevant processes, regulations, and clinical materials Provides assistance or guidance in partnership with learning and innovation when needed Participates in developmental discussions and receives feedback from supervisors

Job Duties: Review fax documents appropriately and forward them to the appropriate queues Review each document for accuracy and place the case in the proper queue Perform data entry related to Coverage Determination and Appeal fax queues Research reports as needed Maintain complete, timely, and accurate documentation of Coverage Determination and Appeal requests Escalate issues to Coverage Determination/Appeal pharmacists or management staff as needed Update and maintain knowledge of relevant processes, regulations, and clinical materials Maintain schedule flexibility, including rotations through nights, weekends, and holiday coverage Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.