What are the responsibilities and job description for the Health Insurance - Prior Authorization position at Wipro Limited?
Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.
Mandatory Skills: Claims_Processing.
Expected annual pay for this role ranges from $25,000 to $50,000 . Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
Job Description
ECS Clinical Coverage Review / Prior Auth
Purpose of Job: Positions in this function are responsible to determine if prior authorization is required and can be decisioned, or if it requires additional clinical review. Individuals support clinicians by contacting health providers and/or members to verify authorization or referral, setup cases, and document findings. Positions in this function includes those responsible for initial triage of members, administrative intake of members and working with hospitals and the clinical team
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Primary Responsibilities
- This is a production role and you will have the responsibility to meet production, quality and regulatory expectation
- Ensure case is set up correctly and document required information
- Review, research and determine if case can be decisioned or if it requires additional clinical review
- Demonstrate proficiency and decision making by solving complex problems using available resources (documents, medical policy, standard operating procedure, etc.
- As needed, make outbound calls to providers and/or members to obtain information regarding a cas
- As needed, make outbound calls to providers to coordinate provider availability in treating member
- Other duties as assigned by manager and/or director
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Qualifications Required
- Minimum of a High School Diploma / GED
- 1 years of professional experience in an office or healthcare environment
- Prior customer service experience making outbound calls
- Proficiency in using a computer
- Experience working with Microsoft Office Products including Microsoft Outlook (ability to create, edit, save, and send emails), Microsoft Word (ability to create, edit, save, and send documents), and Microsoft Excel (ability to create, edit, save, and send spreadsheets
- Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm; Tuesday-Saturday or Sunday-Thursday shifts may be available
- Flexibility to work outside standard hours of operations due to changing business needs
- Ability to trouble shoot and setup computer equipment independently
- Must have a designated work area established that is separate from other living areas and can be secured to maintain PHI or PI security in line with Wipro policies and standards
- Must live in a location that can receive a dedicated hardwired high-speed internet connection or leverage an existing high-speed internet service provider (ISP) (minimum speed 1.5 download mps and 1 upload mps).
Preferred
- Previous experience working with back office medical platforms and/or authorizations systems
- Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Service
- Professional experience in a Clerical or Administrative support related role
- Able to quickly learn various computer systems or applications
Expected annual pay for this role ranges from $25,000 to $50,000 . Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
Salary : $25,000 - $50,000
