SrAdmin-Appeals

Additional Information:
Remote
Hours: 8-5 PST (Can be flexible)
Pay rate: ***
Same bill rate as Sr*** Admin - Appeals (Pittsford)
Must pass full background check prior to starting
Contract to hire (6+ months of contracting)
Interview: Phone/TEAMS interview

Day-to-Day Responsibilities
Reviewing and analyzing cases, assessing data, and performing data entry tasks.
More than just basic data entry requires evaluating case eligibility and making informed decisions.
Conducting cognitive analysis beyond simple data processing.
Utilizing critical thinking to assess cases effectively.

Candidate Background & Experience
No medical background required, but candidates with experience in medical transcription may perform better.

Relevant experience could include roles such as:
Medical assistant
Previous work in a medical facility
Medical transcription
Insurance billing
Familiarity with medical terminology
Strong keyboard skills and a data entry background are necessary.

Project Product
Reviewing worker claims for the state of California, which may involve:
Medications
Therapy
Surgical procedures

Workflow & Systems
The job is production and quality-based, requiring cases to be reviewed from start to finish.
Entering information into *** system and determining the appropriate next steps for the case.



Preliminary Review Job Description
Essential Duties and Responsibilities:
- Review and analyze data submitted for independent medical review (IMR) including applications, utilization reviews etc.
-Perform data entry tasks with accuracy.
-Perform other duties as may be assigned by management

•*********Minimum Requirements:
- High School Diploma or Equivalent required; Associate degree preferred.
- 1 to 2 years of related experience required.
- Medical-related experience preferred.