Health Services Assistant
: Job Details :

Prior Authorization may process emergent/elective and transitional prior authorization requests according to established evidenced based criteria. Screens prior authorization requests not meeting guidelines and requests/gathers/forwards additional information. May conduct utilization review by monitoring daily prior authorization requests and documenting timely updates for service requests. Completes Administrative Denials and submits Medical Director Reviews as directed. Correspondence with Provider/ Member Notifies members and providers including but not limited to approvals, provider notification of service requests and out of network approvals. Coordination of Benefits by monitoring benefit limitations for all members. Identifies members for case management or needed follow up regarding subrogation or coordination of benefits. Refers to appropriate departments as needed. Provides claims follow up as indicated. Documents in multiple computer applications timely and according to unit...Health, Assistant, Medical Director, Monitoring, Healthcare, Service