[Remote] Prior Authorization/Coverage Determination Representative

Note: The job is a remote job and is open to candidates in USA. LanceSoft Inc. is seeking a Pharmacy Advisor Rep I to support members and prescribers in a clinical program. The role involves making outbound calls to assist patients with medication refills, educating them about the program, and managing requests received via fax. Responsibilities • Through the use of sophisticated modeling and systems, we are able to identify members who meet the desired counseling opportunity criteria. • Representatives will be making outbound calls to patients (and fielding return inbound calls) in which the Pharmacy Advisor Rep I will assist patients in refilling medications. • Rep I may also, as necessary, transfer a member with clinical questions to a consulting Pharmacist. • In addition, the Pharmacy Advisor Rep I will be responsible for educating the member on the value and purpose of the program, client-related messages as well as identifying ways to help with medication ordering process and medication cost savings opportunities. • Besides assisting with inbound and outbound calls, the Pharmacy Advisor Rep I will also support requests received via fax with the potential, based on business needs, of cross-training to support other clinical services. Skills • Minimum of 1 year in a customer service or call center environment (call center type environments preferred, if doctors office then anything below managing 75 calls/day would not translate to similar environment). • Must have effective and empathetic communication style in managing inbound calls and communications with clients and team members. • Computer experience is required with proficiency in Microsoft Outlook, Word and Excel. • Basic alpha number data entry skills with attention to accuracy and quality is essential. • Intermediate math skills are required with attention to detail and quality essential. • Ability to work with people in a team environment while meeting individual performance goals. • Must be able to read and interpret policies, procedures and instructions. • Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities is essential. • High School diploma or GED • Experience in a health care setting or insurance industry is a plus, including knowledge of basic insurance and third party terms and medical terminology. Company Overview • Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele. It was founded in 2000, and is headquartered in Herndon, Virginia, US, with a workforce of 5001-10000 employees. Its website is https://www.lancesoft.com. Company H1B Sponsorship • LanceSoft Inc., has a track record of offering H1B sponsorships, with 46 in 2025, 32 in 2024, 23 in 2023, 25 in 2022, 60 in 2021, 80 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job