Job Description
Job Description:-
• Diagnostics procedure such as MRI, CT Scan prior authorization submission and working on the denials received from the insurance company.
• Should be able to review and interpret clinical notes, labs and make appropriate decisions regarding medications and patient's condition.
• Should have complete knowledge of medications i.e. use, therapeutic category, dose, contraindication, drug-drug interaction.
• Should be able to do medication reconciliation, identify polypharmacy or any discrepancy in the medications prescribed.
• Communicates on behalf of the prescribers with the payors, pharmacies, patients, pharma manufacturers.
• Completes prior authorization (PA) for all medications. A thorough review of the patient’s Statement of Medical Necessity must be provided, which includes diagnosis, signs/symptoms of the disease, prior failed treatments, contraindications, laboratory tests and results and any other pertinent medical information for the patient's case.
• Should be able to switch the medications based on the cost, category with appropriate dose.
• Should be able to handle any incoming and outgoing calls, faxes, and emails with professional demeanor.
• Maintains compliance with company policies and procedures, complies with all laws regulating pharmacy services.
• Maintains all PHI according to HIPAA rules.
• Assists in training of new staff members as needed.
• Works independently on other projects as assigned.
• Performs other duties as assigned by management.
• Should be comfortable working in US shift.
Any fresher/ experienced candidate holding life-science degree (B. Pharm/ M. Pharm/ B. Sc/ M. Sc) may apply.
• Diagnostics procedure such as MRI, CT Scan prior authorization submission and working on the denials received from the insurance company.
• Should be able to review and interpret clinical notes, labs and make appropriate decisions regarding medications and patient's condition.
• Should have complete knowledge of medications i.e. use, therapeutic category, dose, contraindication, drug-drug interaction.
• Should be able to do medication reconciliation, identify polypharmacy or any discrepancy in the medications prescribed.
• Communicates on behalf of the prescribers with the payors, pharmacies, patients, pharma manufacturers.
• Completes prior authorization (PA) for all medications. A thorough review of the patient’s Statement of Medical Necessity must be provided, which includes diagnosis, signs/symptoms of the disease, prior failed treatments, contraindications, laboratory tests and results and any other pertinent medical information for the patient's case.
• Should be able to switch the medications based on the cost, category with appropriate dose.
• Should be able to handle any incoming and outgoing calls, faxes, and emails with professional demeanor.
• Maintains compliance with company policies and procedures, complies with all laws regulating pharmacy services.
• Maintains all PHI according to HIPAA rules.
• Assists in training of new staff members as needed.
• Works independently on other projects as assigned.
• Performs other duties as assigned by management.
• Should be comfortable working in US shift.
Any fresher/ experienced candidate holding life-science degree (B. Pharm/ M. Pharm/ B. Sc/ M. Sc) may apply.
💡 Quick Summary
Seeking a career-building opportunity? The Clinical Specialist position is now open for candidates interested in the BPO Jobs sector. This role in Ahmedabad offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in BPO Jobs is a plus.
