Care Review Processor
5 days ago
Remember to check your CV before applying Also, ensure you read through all the requirements related to this role.
Healthcare 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.
*Position Type*: Contract
*Length*: 6 months
*Start Date*: 1/13/2025
*Shift*:
1. Tues-Sat
2. Sunday-Thurs
3. Schedule that includes both Sat/Sun so for example Wed-Sun, Thurs- Mon, etc
For the hours 8:30-5:00 w/ 30 min lunch option for all 3 positions
*Pay Rate*: $23.98 Per Hour
*Job Description:*
* Clerk faxes from the Clerk box to our Coordinator box.
* They will be assisting us with daily call outs to facilities to confirm if member is still in house or has been discharged.
* Assisting with verifying facility and IPA phone and fax numbers.
* There will be some work to do in the Coordinator box side - typically will start them with processing Custodial Care referrals.
*Day to Day Responsibilities:*
Process faxes (requests from providers). Build authorizations, call providers, very computer literate, answer calls from providers.
*Must Have Skills*:
UM experience-Prior authorization, medical terminology, ICD 10 knowledge, CPT codes.
* 2-4 years of experience in a Utilization Review Department in a Managed Care Environment.
* Previous Hospital or Healthcare clerical, audit or billing experience.
* Experience with Medical Terminology.
* Computer skills and experienced user of Microsoft Office software
* Accurate data entry at 40 WPM minimum
* Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity.
* to concerns, proactive identification and resolution of issues to promote positive outcomes for members.
* Demonstrated ability to communicate, problem solve, and work effectively with people.
* Working knowledge of medical terminology and abbreviations.
* Ability to think analytically and to problem solve.
* Good interpersonal/team skills
*Education:*
High School Diploma or G.E.D.
Job Type: Contract
Salary: $23.98 per hour
Benefits:
* Dental insurance
* Health insurance
* Vision insurance
Application Question(s):
* 2 years of experience in a Utilization Review Department in a Managed Care Environment. Previous Hospital or Healthcare clerical, audit or billing experience
* Computer skills and experienced user of Microsoft Office software.
* Must have Medical terminology knowledge
* Some admin experience/preferred some health plan or healthcare setting admin experience
* Must reside in PST
Job Types: Full-time, Contract
Pay: $23.98 per hour
Benefits:
* Dental insurance
* Health insurance
* Life insurance
* Vision insurance
Schedule:
* 8 hour shift
* Day shift
Application Question(s):
* Previous Hospital or Healthcare clerical, audit, or billing experience. Experience with Medical Terminology.
* 1-2 years in a Utilization Review Department in a Managed Care Environment
* Must reside in CST or PST
Work Location: Remote
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