Quality Auditor

Job#: 2074726

Job Description:

Position Quality Auditor - Prior Authorization Digitization

Duration: 6+ month contract

Location: 100% Remote

Number of openings: 3

For applicants who are interested in this opportunity, send your updated resume to [email protected] ( Al exa Whalen - Talent Strategy Team Lead)

Project:

• The Prior Authorization Digitization Auditor is responsible to audit the digitization of all prior authorizations into application.
• This includes ensuring that the translation of the prior authorization documents was populated fully into the correct sections of the application as well as the correct classification of the prior authorization approval criteria by the AI BOT, which performs the digitization.
  
  

Responsibilities:

• Audit each digitized guideline to ensure that all content was correctly populated into the respective sections of the application including formulary id, drug name, effective dates, background information, references and approval criteria.
• Ensure that the AI BOT properly classified each component of the approval criteria from the available classification options and correct any classifications as needed
• Research drug product labeling to assist with the classification guideline criteria as needed.
• Manually digitize any prior authorization criteria document that failed the digitization process
• Ensure consistency of reclassifications for common criteria statement and provide feedback to the BOT team to enhance BOT learning
• Work with IT personnel on any application related issue or enhancement
  
  

Requirements

• HS Diploma, GED or equivalent
• 1+ years of experience working in a pharmacy related role, PBM or Healthcare service environment with knowledge of pharmacy terminology or working with prior authorization guidelines or equivalent experience
• 1+ years of experience working with basic knowledge of Excel: Formatting cells, managing worksheets, data validation, filtering and sorting data.
• Basic knowledge of Word: write and modify word documents
• Computer and reporting skills: ability to understand, generate, organize, compile, and manipulate data reporting systems with minimal training
• Strong verbal and written communication skills; ability to speak and write clearly and concisely to individuals or groups
  
  

Preferred Qualifications

• Pharmacy technician certification preferred.
• Strong problem solving and organizational skills is preferred.
• Intermediate knowledge of Excel (Formatting cells, managing worksheets, data validation, function and formula’s (SUM, VLOOKUP), filtering and sorting data, pivot tables)
• Knowledge of PowerPoint: ability to create and edit slides
  
  

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

Apex Systems is part of the Commercial Segment of ASGN Incorporated.

NYSE: ASGN

4400 Cox Road

Suite 200

Glen Allen, Virginia 23060

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] (Do not submit resumes or solicit consultants to this email address). UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Apex Systems.