UM Review Assistant

Review Assistant

Work Location Type: Remote CA Duration: 6 Months Contract The role is pivotal in streamlining the clinical review process by meticulously preparing prior authorization cases. This individual will uphold a comprehensive understanding of internal policies, procedures, and services, ensuring adherence to organizational standards.

Responsibilities:

• Provide primary non-clinical program support by encompassing provider training, customer service, call triaging, authorization preparation, data entry, and the development and tracking of functions for members and providers.
• Offer non-clinical support to other programs as needed, ensuring flexibility and adaptability in meeting organizational requirements.
• Review patient records for completeness against submission requirements, identifying cases requiring additional non-clinical information.
• Process and document case discharges with precision and timeliness.
• Ensure accurate and prompt submission of all administrative-related documents to relevant parties.
• Act as a liaison with internal and external customers, fostering positive and professional relationships to facilitate an effective review process.
• Attend training and scheduled meetings, maintaining up-to-date information for case preparation.
• Uphold medical records confidentiality through proper use of computer passwords and secured files, adhering to HIPAA policies.
• Answer calls and demonstrate proper telephone etiquette and communication skills in alignment with Client Health's policies, procedures, and guidelines.
• Cross-train to perform duties of other contracts within the Client Health network, contributing to a flexible workforce to meet client/consumer needs.
• Fulfill other assigned duties to meet contract deliverables and organizational requirements.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

• High school diploma or GED equivalent.
• Associate degree preferred and/or equivalent work experience related to medical, behavioral, or social/support settings.
• 1-2 years of experience in administrative or records management.
• 2-3 years in an administrative support or customer service position and be familiar with healthcare.

Preferred Qualifications

• Comprehensive knowledge of office environments and business processes.
• Understanding of a customer service approach tailored for medical provider stakeholders.
• Familiarity with government structures and related programs is advantageous.
• Excellent communication skills.
• Ability to multitask, prioritize, and provide service to a diverse range of customers.
• Experience in development and project activities.
• Experience in staff and provider training, with preferred public speaking skills.
• A proactive approach to continually assess office functions and report potential issues to the Director.
• Capability to track provider issues and report them appropriately.
• Willingness to learn the Atrezzo application and assist customers in resolving technical issues related to the submission of Health Homes authorization requests.
• Proficiency in Microsoft Office applications and Excel, ensuring efficient utilization of essential software tools.

Metasys Technologies is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Metasys Technologies, Inc.