job summary : Responsibilities :

Responsibilities :

• Initiate authorization requests for output or input services in keeping with the prior authorization list.
• Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
• Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services.
• Screen members by priority for case management (CM) assessment.
• Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
• Coordinate services with community based organizations.
• Attend marketing and outreach meetings as directed to represent the plan.
• Produces and mails routine CM letters and program educational material.
• Data enter assessments and authorizations into the system.

Skills : Prior Authorization, Eligibility, Insurance benefits Experience : Experienced

responsibilities :

• Initiate authorization requests for output or input services in keeping with the prior authorization list.
• Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
• Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services.
• Screen members by priority for case management (CM) assessment.
• Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
• Coordinate services with community based organizations.
• Attend marketing and outreach meetings as directed to represent the plan.
• Produces and mails routine CM letters and program educational material.
• Data enter assessments and authorizations into the system.

qualifications : Experience

Experience

Experienced

Education

High School (required)

skills :

• Prior Authorization
• Eligibility
• Insurance benefits
2 hours ago