IL
Representative II
ICONMA, LLC
🇺🇸 United States
Remote
Entry level
1 month ago
$1.00 – $20.28 / hour
- CMS
- Windows
1 month ago
Not enough detail in this posting to match
Responsibilities:
- Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
- Pharmacy or medical background is preferred.
- Successfully worked independently in a data entry, productivity driven role is preferred
- As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal:
- As a Rep II, Operations, you will support Medicare members, prescribers, and providers by processing coverage-related requests across both phone and fax (offline) channels.
- This role integrates responsibilities previously segmented by channel (phone vs. fax) and line of business (Medicare Part D and applicable Medicare Part B processes), reflecting the organization’s modularized training model in which colleagues progressively learn, practice, and apply end to end skills before fully transitioning to production work.
- Responsible for accurate case setup, review, outreach, documentation, and timely resolution of requests in accordance with Medicare guidelines, CMS-mandated timelines, and internal quality standards.
- Demonstrate strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment.
- Work will be performed through a combination of inbound and outbound phone interactions and fax-based casework.
- This role reflects an integrated Rep II model aligned with modularized training.
- Colleagues are trained across both phone and fax-based workflows and progressively apply learned skills through practice before full production deployment.
- Channel assignment (phone vs. offline work) and case mix may vary based on business needs, proficiency, and operational demand.
- Any remaining discrepancies between legacy role definitions (phone vs. fax, Part D vs. Part B) can be addressed individually without altering the core scope of this position.
- Case Intake, Review, and Processing (Phone & Fax)
- Process incoming coverage-related requests (e.g., prior authorizations, coverage determinations, drug benefit exceptions, appeals) via phone and fax from members and prescribers.
- Accurately set up cases, review documentation, and apply work instructions to ensure correct and timely processing.
- Read, analyze, and interpret business correspondence, technical procedures, and Medicare regulations to support decision-making.
- Outreach and Information Gathering
- Conduct outbound calls to members and providers to obtain missing or additional information required to complete requests.
- Communicate clearly, professionally, and empathetically while projecting a positive business image.
- Documentation, Accuracy, and Compliance
- Provide clear, concise, and accurate documentation of all case activity across systems.
- Ensure all cases are properly closed and meet CMS-mandated timelines, department productivity expectations, and quality standards.
- Identify and research issues in the overall process and correct errors when identified.
- Escalation and Collaboration
- Raise complex issues or clinical questions to Coverage/Organization Determination Clinical Pharmacists or management as appropriate.
- Collaborate with peers, trainers, and leaders while progressing through modular training and skill expansion.
- Continuous Learning and Development
- Acquire and maintain working knowledge of evolving work instructions, systems, and Medicare guidance (Part D and applicable Part B processes).
- Participate in coaching, feedback, and development discussions with direct leadership. has context menu
Requirements:
- Minimum of 6+ months customer service, healthcare, pharmacy, call center, or related experience.
- Strong verbal and written communication skills.
- Ability to problem-solve and manage multiple concrete variables in standardized situations.
- Proficiency navigating multiple computer systems simultaneously in a Windows-based environment.
- Ability to interpret work instructions delivered through multiple systems and formats.
- Ability to perform basic mathematical calculations.
- Call center experience.
- Experience in a PBM, managed care, or healthcare environment.
- Experience handling confidential patient or member information.
- Familiarity with multi-system workflows (e.g., claims platforms, case management systems, internal databases).
- Pharmacy Technician Certification (CPhT) or related education.
- High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
Representative II · ICONMA, LLC