Job Description
Are you a tech-savvy customer service professional looking for a flexible, work-from-home opportunity? We are seeking dedicated Clinical Services Representatives to provide vital, top-tier phone assistance and administrative support for prior authorization processing!
In this fully remote position, you will take high-volume inbound calls from healthcare providers, pharmacies, and members, guiding them through criteria-based prior authorizations. You will be responsible for maintaining accurate data entries, monitoring departmental mailboxes, and processing electronic prior authorizations via fax and ePA. When complex clinical questions arise, you will seamlessly route them to the pharmacist team. Operating from your dedicated, quiet home office with a hardwired internet connection, you'll utilize your medical terminology knowledge and strong multitasking skills to ensure swift, high-quality outcomes.
salary: $18.23 - $18.24 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Position Summary: Provide professional telephone assistance for criteria-based prior authorizations, maintain accurate case documentation, process electronic requests, and transfer clinical queries to pharmacists.
Key Responsibilities: - Handle inbound calls from providers, members, and pharmacies regarding prior authorization requests.
- Process prior authorization paperwork received through ePA, fax, and departmental mailboxes.
- Accurately document review details and escalate complex clinical decisions to the pharmacist team.
- Conduct outbound calls to gather missing information and fulfill daily production goals.
Requirements: - High School Diploma or GED required.
- 0–3 years of experience in prior authorization, call center, customer service, or data entry.
- Basic understanding of pharmaceutical terminology, calculations, and protocols.
- Dedicated private home office with a hardwired Ethernet connection (25 Mbps download / 3 Mbps upload minimum).
- Full availability for mandatory 1-month training (Monday – Friday, 8:00 AM – 4:30 PM EST).
Skills
- Call Center Support
- Patient Support
- Follow-up
- Telephone Etiquette
Qualifications
- Years of experience: 2 years
- Experience level: Experienced
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Remote work, Home office, Monday to Friday, Flexible hours, Shift work