Job Description:
• Responsible for initial review and triage of claims
• Determines coverage, verifies eligibility, identifies and redirects misdirects
• Responsible for prepping the authorization in the system and triage cases to medical staff for review
• Organized and prioritizes work to meet regulatory and claim turn-around times
• Promotes communication, both internally and externally to enhance effectiveness of medical management services
• Performs non-medical research and support
• Adheres to Compliance with PM Policies and Regulatory Standards
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Requirements:
• Effective communication, telephonic and organization skills
• Familiarity with basic medical terminology and concepts used in care
• Strong customer service skills to coordinate service delivery
• 2-4 years experience as a medical assistant, office assistant or claim processor preferred
• MedCompass, CEC, or ACAS experience preferred
• High School Diploma or G.E.D
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now