Job Description

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 service the Connecticut Medicaid account. This fast-paced position is responsible for answering and providing information/clarification/resolution to prescribers and pharmacies with respect to pharmacy claims and prior authorization questions within established standards. The representative, along with 7 other team members, is required to process all pharmacy prior authorizations received within 2 hours of receipt. On-call and/or working second or thirds shifts is required on a rotational basis. 

Your role in our mission

• Answer telephones and respond to basic and complex pharmacy questions from providers.
• Analyze pharmacy claims to respond to provider inquiries.
• Provide verification and explanation of pharmacy benefits to providers upon inquiry.
• Document each call inquiry and response provided accurately and with the appropriate amount of detail.
• Process prior authorization form requests, approved or denied, and document prior authorization records with rationale for approval vs. denial.

What we're looking for

• Knowledge of pharmacy claims and dispensing systems.
• Ability to work independently within a high-paced, team environment with little direct supervision.
• Strong multi-tasking, business, and analytical problem-solving skills.
• Proficiency in Medicaid & Medicare Part D, MS Office Suite, and managing mailboxes in Outlook.
• Excellent organizational, time management, and communication skills.
• Ability to maintain confidentiality, comply with HIPAA, and establish positive work relationships.
• Connecticut Licensed (Active) Pharmacy Technician.
• Pharmacy Technician Certification – National (preferred).
• Must reside in the State of Connecticut.

What you should expect in this role

• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• Full-time (40 hours a week)
• Most benefits start on first day of employment
• Remote (work from home)
• In order to effectively work as a teleworker with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
• Call center provides support 24 hours per day, 7 days a week, 365 days a year. Call Center is staffed M-F 7:30 AM – 7:30 PM, and (rotating schedule for Saturdays) Saturdays 9 AM – 4 PM. All off hours are covered on an on-call rotation.

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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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. 

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