Clinical Coordinator

Company Bio:

Founded by industry pioneers, SlateRx provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry’s only PBXTM, SlateRx is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members.

Job Overview:

As a Clinical Coordinator, you will be responsible for supporting the clinical functions of coverage determinations and appeals in accordance with the policies and practices of SlateRx, LLC. This position will be responsible for ensuring efficiency, accuracy, and timeliness in reviewing coverage determinations and appeals.

Responsibilities:

As a Clinical Coordinator, your key responsibilities will include:

• Create case files and transcribe clinical documentation for coverage determination and appeal requests.
• Research claim reject messaging associated with coverage determination and appeal requests for pharmacist review.
• Contact prescriber offices to obtain additional information.
• Configure authorized coverage determination and appeal outcomes in the adjudication system after completion of review and decision by the pharmacist or client.
• Handle inbound phone calls from prescribers and members regarding coverage determinations.
• Respond to routine inquiries and correspondence regarding coverage determinations and appeals with members, prescribers, and pharmacies as applicable.
• Notify physicians, members, and other health professionals as applicable, of coverage determination request decisions.
• Ensure timely and accurate processing of requests.
• Maintain compliance with established protocols and regulations from governing and accrediting agencies..
• Perform miscellaneous job-related duties as assigned.

Qualifications:

To excel in this role, you should possess the following qualifications:

• Knowledge in the healthcare, insurance or PBM industry.
• Experience in pharmacy benefit management, coverage determination, appeals and grievance (CDAG) operational processes, and regulatory requirements.
• Computer and typing proficiency.
• Ability to adapt to a dynamic and fast-paced environment.
• Motivated individual who is well-organized and able to work with minimal amount of supervision.

Education:

High school diploma or GED required; Bachelor’s degree strongly preferred.

License Requirement:

Current and valid Pharmacy Technician Certification, Licensure, or Registration is required.

Job Benefits:

Health, Dental, Vision, Life, 401k, Paid Time Off.

Location:

Remote