Duties & Responsibilities:
- 85% - Medical Authorization Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Receives inpatient requests via fax, phone or electronically and enters data of new case information into the medical management system. Creates inpatient events based on facility face sheets and/or clinical received. Verifies member eligibility. Collects additional information from *** Health members and/or providers/facilities to complete prospective, concurrent or retrospective inpatient service reviews. Authorizes requested services according to *** Healths Concurrent Review team guidelines. Contacts the health networks and/or *** Health Customer Service department regarding health network enrollments. Assists the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnosis and procedures, discharge dates, dispositions and conducts follow-up phone calls per concurrent review team standards. Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Receives inpatient requests via fax, phone or electronically and enters data of new case information into the medical management system. Creates inpatient events based on facility face sheets and/or clinical received. Verifies member eligibility. Collects additional information from *** Health members and/or providers/facilities to complete prospective, concurrent or retrospective inpatient service reviews. Authorizes requested services according to *** Healths Concurrent Review team guidelines. Contacts the health networks and/or *** Health Customer Service department regarding health network enrollments. Assists the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnosis and procedures, discharge dates, dispositions and conducts follow-up phone calls per concurrent review team standards.
- 10% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Documents all contacts and case information in the system using the standard charting format. Enters data into the appropriate databases for monitoring and tracking, trending of inpatient events and other relevant databases as needed. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Documents all contacts and case information in the system using the standard charting format. Enters data into the appropriate databases for monitoring and tracking, trending of inpatient events and other relevant databases as needed.
- 5% - Completes other projects and duties as assigned.
Minimum Qualifications:
- High School diploma or equivalent required.
- 2 years of experience in a health care or managed care setting required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:
- Previous medical billing and coding experience.
- Certified medical assistant (CMA) certification.
- Concurrent review and utilization management experience.
- Bilingual in English and in one of *** Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
Knowledge & Abilities:
- Develop rapport and establish and maintain effective working relationships with *** Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,national origin, disability, or status as a protected veteran.