Central Scheduler

Care Review Processor

Job Title: Care Review Processor

Duration: 4+ months contract

Location: Texas USA 79902

Hours: Mon-Fri 8:00 AM to 5:00 PM

Top Three Skill Sets: Customer Service, Computer Skills and medical terminology

Job Description:

• Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits, Determine provider contracting status and appropriateness, Determine diagnosis and treatment request Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), Determine COB status, Verify inpatient hospital census-admits and discharges, Perform action required per protocol using the appropriate Database.
• Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Client's operational timeframes.
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care.
• Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.
• Provide excellent customer service for internal and external customers.
• Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.
• Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
• Meet productivity standards.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

EDUCATION:

• Accurate data entry at 40 WPM minimum.
• Required Education: High School Diploma/GED
• Required Experience: 1-4 years of experience in a Utilization Review Department in a Managed Care Environment.
• Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical Terminology