Care Review Processor

Job Title: Care Review Processor

Duration: 4+ months contract

Location: Texas USA 79902

Hours: Mon- Fri 8:00AM to 5:00 PM

Top Three Skill Sets: Customer Service, Computer Skills and medical terminology

Job Description:

• Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits, Determine provider contracting status and appropriateness, Determine diagnosis and treatment request Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), Determine COB status, Verify inpatient hospital census-admits and discharges, Perform action required per protocol using the appropriate Database.

• Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Client’s operational timeframes.

• Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care.

• Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

• Provide excellent customer service for internal and external customers.

• Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.

• Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.

• Meet productivity standards.

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

EDUCATION:

• Accurate data entry at 40 WPM minimum.

• Required Education: High School Diploma/GED

• Required Experience: 1-4 years of experience in a Utilization Review Department in a Managed Care Environment.

• Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical Terminology

Additional Information

All your information will be kept confidential according to EEO guidelines.