Care Review Processor I

Job Summary:

• Services (client) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.
• Client staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
• As part of this role, the selected candidate will be scheduled to work weekends in alignment with department coverage needs.

Day to Day Responsibilities:

• Provides telephone, clerical, and data entry support for the Care Review team.
• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
• Responds to requests for authorization of services submitted via phone, fax, and mail according to Client operational timeframes.
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

Required Education:

• HS Diploma or GED.

Preferred Education:

• Associate degree.

Preferred Experience:

• 3+ years’ experience in an administrative support role in healthcare, Medical Assistant preferred.
• Experience with Medical Terminology.

Work Schedule:

• 100% remote but most work PST hours.