Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
- This role involves evaluating referral and pre-certification requests in accordance with contractual obligations and regularly interacting with physician offices to assist with prior authorizations.
- Communicates well both verbally and in writing
- Creates accurate and punctual reports
- Delivers presentations and shares information and ideas with others
- Develops and maintains good working relationships with team members, other departments, medical directors, and provider offices
- Breaks down problems into smaller components and understands underlying issues
- Answers phones regarding questions related to prior authorization
- Manages a fair workload and volunteers for additional work
- Follows documented processes to review healthcare service requests
- Seeks out and accepts feedback, is a proactive learner
- Builds customer confidence and is committed to increasing customer satisfaction
- Participates as part of the Prior Authorization team by actively interacting with other team members
- Evaluates referral and pre-certification requests to determine eligibility and network affiliation
- Qualifications
- High School diploma/GED; MA or Associates degree highly preferred
- One to three years healthcare experience required (medical office, healthplan, etc.)
- One to three years utilization management experience highly preferred
- Knowledge of medical terminology required
- Knowledge of medical coding, NCQA and Medicare Guidelines required
- Proven customer service skills required
- Excellent written and verbal communications skills required
- Skilled in computer competency using Microsoft Outlook, Word and Excel
- Ability to work in a windows based environment utilizing numerous programs at once
- Ability to work in a fast-paced environment
- Ability to identify and solve practical problems
- Ability to maintain positive and effective work relationships with coworkers, clients, members, and providers
- Strong organizational skills
- Strong attention to detail
- Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures
- Requirements
- Salary Range: $19.71 - $26.28
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