Clinical Review Coordinator
3 weeks ago
Job Description
">We are seeking a highly organized and detail-oriented individual to join our team as a Healthcare Management Associate. In this role, you will be responsible for:
">- ">
- Evaluating and responding to clinical review requests from healthcare providers;">
- Verifying member eligibility and benefit information to ensure accurate claims processing;">
- Collaborating with vendors to resolve authorization issues and update claims processing accordingly;">
- Developing and maintaining accurate electronic records within our Utilization Management system.">
Responsibilities
">In addition to the above duties, you will also be responsible for:
">- ">
- Triaging and distributing clinical review requests to respective teams based on type of service, place of treatment, provider relationship, and line of business;">
- Notifying and communicating issues associated with authorization files with unit coordinators, supervisors, or UM Solutions Administrators;">
- Escalating calls as appropriate, taking into account urgency, customer level of concern, and required knowledge to respond accurately.">
Required Skills and Qualifications
">To succeed in this role, you will need:
">- ">
- An Associate's degree or equivalent combination of education and work experience;">
- Good customer service skills and strong verbal communication abilities;">
- Working knowledge of basic office equipment and Microsoft Office applications;">
- Familiarity with CPT/HCPCS coding and medical terminology.">
Estimated Salary
">$60,000 - $75,000 per year, based on location and experience.
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