Pharmacy Prior Authorization Representative - Remote CT

Date: Feb 24, 2025

Location:

Any city, CT, US, 99999

Req ID: 29518

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Pharmacy Prior Authorization Call Center Representative will play a critical role in supporting the Connecticut Medicaid account. In this fast-paced, high-volume call center role, you will assist prescribers and pharmacies with pharmacy claims and prior authorization inquiries, ensuring timely and accurate processing within two hours of receipt.

This position requires flexibility to work rotating shifts, including second and third shifts, as well as on-call availability as needed.

Your role in our mission

Serve as a primary point of contact for prescribers and pharmacies, answering questions related to pharmacy claims and prior authorizations.
Review and process prior authorization requests, ensuring compliance with Medicaid guidelines and pharmacy benefit policies.
Analyze pharmacy claims data to identify issues and provide timely resolutions.
Accurately document call interactions, inquiries, and resolutions in the system.
Maintain strict compliance with HIPAA regulations and confidentiality standards.
Collaborate with internal teams to support continuous process improvements and enhance customer satisfaction.

What we're looking for

Strong customer service and problem-solving skills in a fast-paced environment.
Knowledge of pharmacy claims processing and prior authorization requirements.
Ability to effectively multi-task and prioritize responsibilities.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and telephone systems.
Strong verbal and written communication skills with attention to detail.
Flexibility to accommodate rotating work schedules, including weekends and on-call shifts.

What you should expect in this role

Remote work opportunity, but must reside in Connecticut.
Potential for in-office work in East Hartford as needed.
24/7/365 call center environment with rotating shifts:
- Monday – Friday: 7:30 AM – 7:30 PM
- Saturday (rotating schedule): 9:00 AM – 4:00 PM
- All off-hours are covered on an on-call rotation.
A dynamic and fast-paced call center environment where accuracy and efficiency are key.
Work from Home: Reliable high-speed internet connectivity is essential. Minimum requirements are 24 Mbps download and 8 Mbps upload, with higher speeds recommended for optimal performance.
Interview Requirement: Video cameras must be used during all interviews.

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The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.