Supports customer service activities and initiatives for a number of products or clients including but not limited to the Case Management and Utilization Management departments.
Job Description
Screen incoming calls and/or faxes or other digital format for UM and/or CM and direct calls/faxes/other digital requests to the appropriate area. Identify and refer cases appropriately to the Case Management and/or Transition of Care department.
Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned.
Load complete organization determination/notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines.
Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, giving direction as necessary.
Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.
Must be able to pass required testing.
Participation and attendance are mandatory.
This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.
Work overtime as required
Education: High School Diploma or equivalent
Experience 1 year - Customer service experience is required
Skills\Certifications
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Proficient oral and written communication skills
Proficient interpersonal and organizational skills
Exceptional time management skills
Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment
Independent, Sound decision-making and problem-solving skills
If current employee with the company, must meet minimum performance expectations
Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health.
Knowledge and understanding of Medical terminology
Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic
Ability to talk and type simultaneously in a clear and concise manner while interacting with customers
#TB_HC
Seniority level
Entry level
Employment type
Contract
Job function
Health Care Provider
Industries
Staffing and Recruiting
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