What are the responsibilities and job description for the HCS Data Rx Specialist II position at University Health Alliance?
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HCS Data Rx Specialist II
Department: Health Care Services
Position Summary:
This position will conduct administrative functions for the Health Care Services Data & Pharmaceutical team. When needed, provide general administrative support to the other Health Care Services department teams, i.e.: Management, Clinical and Administrative. Always maintain and follow department policy and procedures while also ensuring URAC standards, criteria and guidelines are met.
Essential Duties & Responsibilities:
- Handle inbound and outbound telephone calls related to pharmaceuticals (prior authorization inquiries, CEM, vacation, PLA inquiries, pharmacy inquiries)
- Process incoming drug request overrides (via phone or fax) by determining validity of the request, if not sent to the PBM/CCUM
- Assist with non-clinical review of Rx prior authorizations, data entry, and proper process for clinical review.
- Utilize and navigate various database systems, both internal and external
- Request additional clinical notes as needed.
- Retrieve messages from the telephone answer service and add messages to the Voicemail system.
- Discuss inquiries with other staff and/or departments to resolve any issues.
- Retrieve and file electronic documents and various faxes.
- Assign to the appropriate staff, prior authorization file and/or designated folder.
- Open, scan and distribute mail.
- Coordinate meetings and conference calls by confirming availability of all participants as well as availability of conference room or offsite facility.
- Electronic filing of completed member records and/or any other miscellaneous documentation.
- Update the system as necessary or return the file to the proper HCS staff to make corrections.
- Assist with the creation, updating and revising of Health Care Services educational materials as necessary, including PowerPoints or other materials.
- Accurately maintain and update department policies and procedures, performing Quality Control (QC) reviews as necessary
- Perform other duties and/or projects as assigned by the HCS Data/Rx Supervisor or management.
- Request for additional duties or to be crossed trained in other duties when workload permits.
- This Position prohibits any activity that requires interpretation of clinical information to Customers, including the choosing of a set of criteria to use for handling a request for healthcare services or treatment.
Required Education and Experience:
The individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Two years of previous administrative or clerical experience, preferably in a health care
- High School diploma or equivalent
Preferred and Advanced Qualifications:
- Associate degree from an accredited university/college
- CPC (Certified Professional Coder) designation is desired
- Administrative or clerical experience in a health care related setting
Physical Demands/Working Conditions:
The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.
See Associate Handbook – Employment Policies – Position Descriptions for general work environment.
This position is eligible to work from home upon manager’s approval
- Only Hawaii resident will be considered**
Competitive compensation & excellent benefits offered
Visit our website at https://uhahealth.com/page/career-opportunities to apply and for details about vacant positions.
An Equal Opportunity Employer