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Clerical Assistant
2 months ago
About the Role:
This position supports the Health Services and Utilization Management functions by acting as a liaison between Members, Physicians, Delegates, Operational Business members, and Member Service Coordinators.
Responsibilities:
- Perform review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
- Handle 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 the appropriate system for clinical review.
- Initiate 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.
- Review professional medical/claim policy related issues or claims in pending status.
- Authorize services based upon scripts or algorithms used for pre-review screening upon collection of clinical and non-clinical information.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.
Education Qualification:
- High School Diploma required. Some College preferred.
Required Skills:
- Knowledge of medical terminology.
- Good Oral and Written Communication skills.
- Ability to make sound decisions under the direction of Supervisor.
- Knowledge of contracts, enrollment, billing & claims coding/processing preferred.
- Knowledge of Managed Care principles preferred.
- Ability to analyze and resolve problems with minimal supervision.
- Ability to use a personal computer and applicable software and systems.
- Team Player with strong Analytical and Interpersonal Skills.
