Collects specific data in the medical management information system for the clinical staff. Resolves authorization issues as well as troubleshoots, researches and resolves related issues in a timely and efficient manner. Works under general supervision.

$20.98 - $26.23 Hourly

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools.
• Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication.
• Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved.
• Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions.
• Provides triage and management of calls ensuring that established call performance targets are consistently achieved.
• Provides feedback to leadership regarding training needs
• Collaborates with management to determine the best approach to service customers, handle repeat vendor issues and other job-related matters to maximize and improve delivery, billing and payment of goods and services.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Participates in special projects and performs other duties as assigned.

Education:

• High School Diploma or equivalent Required

Work Experience:

• Minimum of two years of experience in a customer service role Required
• Excellent oral and written communication skills Required
• Advanced personal computer skills, including Word, Excel or Access Required
• Utilization Management experience Preferred