What are the responsibilities and job description for the Clinical Administrative Assistant position at Employee Health Insurance Management Inc?
Job Description
Job Description
Specific Responsibilities :
- Provide direct assistance with the Prior Authorization process to include accumulating the necessary medical supporting documentation and researching the plan sponsor benefit plans.
- Maintain Document Tracking system of Clinical Interventions including Prior Authorizations, Appeals and Step Therapy claims.
- Develop outstanding intervention log for follow-up.
- Compose denial letters to physicians and members.
- Develop archiving and document disposal procedures.
- Assist with generating reporting stats of clinical activity.
- Assist with plan design updates in the PBM application.
- Performs clerical functions including data entry, filing, and sorting, typing, checking and recording information.
- Assists in the preparation of correspondence and distributes materials.
- Review daily utilization exception reporting to determine areas which may require special attention related to chronic conditions.
- Run daily reports as needed (reject reporting, min / max reporting etc.)
- Assist with new group implementation and plan set-up as needed.
- Handle pharmacy call center calls as needed up to and including participating in the after hours rotation schedule.
- Various duties as assigned.
Position Requirements :