Responsibilities:
- Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
- Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
- Prepare, document and route cases in appropriate system for clinical review.
- Initiates call backs and correspondence to members and providers to coordinate and clarify benefits.
- Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.
- Reviewing professional medical/claim policy related issues or claims in pending status.
- Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening. *Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.
- Perform other relevant tasks as assigned by Management.
Core Individual Contributor Competencies: Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus Accountable Learn Communicate
Qualifications: Education: - High School Diploma required. Some College preferred.
Work experience: - Prefer 1-2 years customer service or medical support related position.
Specialized knowledge/skills: Requires knowledge of medical terminology Requires Good Oral and Written Communication skills Requires ability to make sound decisions under the direction of Supervisor knowledge of contracts, enrollment, billing & claims coding/processing knowledge Managed Care principles Prefer the ability to analyze and resolve problems with minimal supervision Prefer the ability to use a personal computer and applicable software and systems Team Player, Strong Analytical, Interpersonal Skills
Prior Healthcare exp required.
Job Type: Contract
Pay: $15.00 - $18.00 per hour
Expected hours: 40 per week
Experience level:
Shift:
Weekly day range:
Work setting:
Experience:
- customer service or medical support related position.: 2 years (Required)
- Healthcare: 1 year (Required)
Work Location: Remote