Lamar Smith Email & Phone Number

New York, New York, United States

Serving as the primary liaison between providers, healthcare facilities, and members;Consistently and accurately utilizing evidence based prior authorization criteria to ensure specialty drugs are being used safely, effectively, and appropriately by assessing provider submitted clinical documentation for clinal appropriateness based on predetermined criteria;Utilizing advanced knowledge of regulations of the Centers for Medicare and Medicaid Services to ensure prior authorization reviews are conducted in timeframes set forth;Providing telephonic assistance and education to providers and their staff on the utilization pharmacy benefit program;

New York, New York, United States

Triage Medicare-related coverage determination requests submitted from providers through prior authorization systems;Reviewed coverage determination forms for accuracy and completeness;Assist team in researching and resolving problems involving coverage determinations;Contact providers for additional information to facilitate the coverage determination review;Perform other duties as assigned

New York, New York, United States

Demonstrates compassion and care by proactively identifying and resolving potential problems.Communicates among a number of individuals, including patients, co-workers, insurance companies, and prescribersWorks on a team to fulfill prescription orders from start to finish with an in-depth understanding of each workstationUnderstands and follows applicable Federal and State laws (e.g., HIPAA), regulations (e.g., OSHA), professional standards, and ethical principles.Complies with CVS policies and procedures to ensure patient safety, and protect patient privacy and security.Balances quality and efficiency in all tasks, contributing to both patient outcomes and broader team goals.

New Hyde Park, New York, United States

Receive and coordinate all program referrals; Savings card activation; Insurance verifications; Run test claims; Billing Error Resolution; Prior Authorization Assistance