Care Review Processor I

Job Description:
100% remote but most work PST hours

Job Description:
Services (HCS) 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. HCS 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.

Job Qualifications
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.

Must Have Skills:
1-3 years experience in an administrative support role in healthcare.

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 Years of Experience:
1-3 years experience in an administrative support role in healthcare.

Experience. Experience with Medical Terminology.

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