Appeals Technician (temp-to-hire)

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx , a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™ , which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health . Position Summary: Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity. Work with appeals team for multiple lines of business such as Commercial, Exchange and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors. Position Responsibilities: Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements. Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies. Review all cases received, to verify if case meets qualifications for appeal review. Performs triple check to ensure quality reviews and handling in accordance with policies and procedures. Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations. Communicate effectively with appeal pharmacists regarding internal and external appeals. Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call. Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers. Performs all other related duties as assigned Minimum Qualifications: 1 + years’ experience working as a certified pharmacy technician in a managed care or PBM setting required. Active, unrestricted PTCB or NHA Certified Pharmacy Technician certification required. Excellent organization details and strong detail orientation. Strong oral and written communication skills. Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities. Ability to work 12pm-9pm EST hours Preferred Qualifications: Experience working with commercial and medicare appeals preferred Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Remote, US Salary Range $60,000.00 - $65,000.00 USD New York, NY Salary Range $78,800.00 - $98,500.00 USD Denver, CO Salary Range $72,000.00 - $90,000.00 USD About Capital Rx Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare. Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary Range $60,000 — $65,000 USD All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy .