Medical Claims Coordinator
4 days ago
About the Role
As a Medical Claims Coordinator at Elevance Health, you will play a vital part in ensuring our members receive the best possible care. We are seeking an experienced professional to join our team as a Utilization Management Representative I. In this role, you will be responsible for coordinating cases for precertification and prior authorization review.
Your Impact
- You will manage incoming calls or incoming post services claims work.
- You will determine contract and benefit eligibility, providing authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
- You will refer cases requiring clinical review to a Nurse reviewer.
- You will be responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
- You will respond to telephone and written inquiries from clients, providers, and in-house departments.
- You will conduct clinical screening processes.
- You will authorize initial sets of sessions to providers.
- You will check benefits for facility-based treatment.
- You will develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Requirements
- A high school diploma or GED is required.
- A minimum of 1 year of customer service or call-center experience is preferred; or any combination of education and experience that would provide an equivalent background.
- Medical terminology training and experience in the medical or insurance field are preferred.
- FHPS experience is also preferred.
Benefits
- This position offers a competitive salary range of $45,000 - $60,000 per year.
- We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
- Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
- Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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