Review Assistant/CSR

1 week ago

West Des Moines, IA, United States Accede Solutions Inc. Full time

The Review Assistant II is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.

Essential Functions

    • Interprets review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates, and communicating the authorization for requested services.
    • Coordinates, distributes, and tracks highly confidential medical information from multiple sources (fax, web, and phone). Interprets and adheres to URAC standards for assigned programs as well as federal and state requirements.
    • Ensures quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritizes workload to meet program or regulatory time frames.
    • Provides verbal and written communications of review decisions to include administrative denials. Completes service/treatment screens for accurate transmission of outcome decisions.
    • Provides general office support and performs miscellaneous duties as assigned
Requirements
    • High school diploma or equivalent
    • 2 years experience working in a customer service or healthcare environment
    • Demonstrated ability working with confidential information and in a deadline-driven environment
    • Excellent verbal and written communication skills and intermediate PC skills.
    • Must reside in central Iowa with the ability to work on-site one day per month.
    • Experience in a healthcare environment preferred.
    • Satisfactory completion of medical terminology course preferred.
    • Intermediate PC functions preferred.

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