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Healthcare Analyst

2 months ago


Woonsocket, United States Global Pharma Tek Full time
Position Title: Healthcare Analyst
Duration: Months with possibility of extension
Location: Remote
Shift hours: :a - :p Mountain Time Monday - Friday.

NOTE: Candidate can reside anywhere in the US (must be able to work -: MST)

Position Summary:
Healthcare Analyst position would work within the Commercial and IFP membership of the Behavioral Health Division of company.
Would work closely with Medical Directors, Clinicians and Customer Service to process higher level reviews.
The Healthcare Analyst would be an integral part of managing our state policies, our NCQA accreditation, and helping our members get the help and documentation that they need.

Duties:
Provide service to clinical teams in support of optimal care.
Generates administrative and medical necessity denial letters, checking for accuracy and appropriateness.
Makes calls to providers and utilization reviewers to provide results of medical necessity determinations and provides specifics for next steps.
Schedules and coordinates appointments between providers or attending physicians and company Medical Directors or Consultants.
Collects and provides necessary material for appointments. Calculates deadlines for appointments and monitor cases for timely return.
Complies with state mandated and company regulations by monitoring documentation, checks for nuances before action taken and follows varying protocols by case or situation.

Required Qualifications:
plus years’ experience in health insurance field and/or
Associates Degree
plus years Administrative/ Secretarial experience and/or
plus years Customer service experience within health care or a mental health capacity
Ability to type - words per minute (please included typing test at top of resume)
Experience in using Microsoft Office including Word, Outlook and Excel

Preferred Qualifications:
Good organizational skills
A go-getter who works independently
Excellent communication

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