Clinical Quality Analyst
Robert Half Accountemps
Description
We are looking for a detail-oriented Prior Authorization Digitization Auditor to join our team on a long-term contract basis. This role involves ensuring the accurate digitization and classification of prior authorization documents into a specialized application. You will play a critical role in maintaining the integrity and consistency of clinical data through audits and manual adjustments. This is a remote position based in Eden Prairie, Minnesota.
Responsibilities:
• Conduct thorough audits of digitized prior authorization guidelines to ensure all content is accurately populated into the designated sections of the application, including formulary IDs, drug names, effective dates, background information, references, and approval criteria.
• Verify and correct AI-generated classifications of approval criteria, ensuring alignment with the appropriate classification options.
• Research drug product labeling to assist in the accurate classification and documentation of guideline criteria.
• Manually digitize prior authorization documents that fail to process through the automated digitization system.
• Ensure consistent reclassification of common criteria statements and provide constructive feedback to the AI development team to improve system learning.
• Collaborate with IT personnel to address application-related issues and recommend enhancements.
• Provide regular updates and reports on audit findings and reclassification efforts to relevant stakeholders.
• Maintain high-quality standards by ensuring all digitized data complies with organizational guidelines and regulatory requirements.
• Support the team with additional tasks related to clinical consulting and digitization processes as needed
Requirements • High school diploma or equivalent is required.
• At least 1 year of experience in a pharmacy-related role or healthcare environment, with knowledge of pharmacy terminology and prior authorization guidelines.
• Proficiency in Microsoft Excel, including tasks such as formatting cells, managing worksheets, data validation, and filtering/sorting data.
• Basic knowledge of Microsoft Word, including creating and editing documents.
• Strong computer and reporting skills, with the ability to generate, organize, and manipulate data effectively.
• Excellent verbal and written communication skills, with the ability to convey information clearly to individuals or groups.
• Attention to detail and strong organizational skills to ensure accuracy in audits and reporting.
• Familiarity with artificial intelligence systems and their application in digitization processes is a plus.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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