Summary of Job: To provide administrative support to the Medical Management Operations team, performing non-clinical tasks as assigned.
Requirements:
Works collaboratively, as a critical component of the concurrent review team, to facilitate all clerical and administrative processes and activities.
Performs accurate and timely intake and data entry for all inpatient notifications and lines of business, upon receipt of inbound utilization management requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements. Triages cases and assigns receipts to appropriate teams.
Responds to inquiries from providers, facilities and members.
Enters and maintains documentation in the medical management workflow tool meeting defined timeframes and performance standards.
Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and accreditation and business standards.
Initiates completion of member and provider correspondence and verbal outreach according to departmental guidelines
Communicates with members and providers regarding member’s authorization status, as required
Adheres to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
Supports communication and coordination with delegated entities, as necessary
Actively participates on assigned committees and projects
Perform other related projects and duties as assigned.
Qualifications:
Associates Degree or Medical Assistant certification preferred
At least 1-2 years of previous call center or data entry experience in a utilization or care management environment within managed care
Strong oral, written and interpersonal communication skills required
Ability to work both independently and collaboratively with others
Previous system user experience in a highly automated environment required with strong PC skills required
Knowledge of medical terminology, ICD-10 and CPT coding preferred
