Supervisor, Coverage Determination

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning …

As the Supervisor, Coverage Determination you’ll support oversight management by coaching, training, and supporting the Coverage Determination team. You’ll assist the specialists with all incoming cases to ensure all Commercial and Medicare coverage determination cases are resolved correctly and on time. You’ll learn and collaborate with additional peers in leadership to ensure all your team members are up to date with the latest changes in regulation (whether state or federally mandated). Additionally, we’ll need your guidance on KPI and quality monitoring while complying with all federal rules and regulations as well as client contracts.

The fundamentals for the job…

• Monitor calls and cases to ensure that all are resolved in a timely and appropriate manner while meeting with respective levels of quality.
• Accomplish key performance (KPI) metrics for cases and areas as assigned.
• Monitor coverage determination performance metrics to ensure proper adjustments are made in a timely manner and the coverages are managed within the standards set by Centers for Medicare & Medicaid Services (CMS) as well as clients.
• Assist CD Specialists in responding to coverage determination requests, and claims pending to be adjudicated for Commercial and Medicare-plan beneficiaries in&