Precertification Associate I

Alliant Health Group is a family of companies that provides professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. Alliant Health Solutions provides Federal and state government entities with the services, expertise and information systems necessary to increase the effectiveness, accessibility and value of health care. The Company has been named a "Best Place to Work 2025" and "Healthiest Employer 2025". Currently Alliant seeks a Precertification Associate is to support Review Nurses with accurate, organized and timely system monitoring, documentation, communication, and management of electronic files. The Precertification Associate performs all administrative duties for assigned workgroup, including documentation of phone calls in PA system, generating appropriate worksheets, logs, letters, and reports. In the role the ideal candidate will perform the following essential job functions: Enter applicable precertification request of information that is received by phone or fax. Work with Review Nurses, Supervisors, and Manager in maintaining the flow of information and communication with providers. Contact provider on issues that can be resolved at this level and send to appropriate Supervisor, Referral Coordinator, and/or Manager any voicemail needing their expertise. Process all incoming phone requests via the PA/UM Call Center phone lines. Meet phone response service level agreements according to MMURS contract agreement. Document thoroughly in the PA record and/or non-PA call log. Pass quarterly audits performed by Supervisors and/or Manager ensuring all calls and changes made to PAs are documented in the appropriate area. Process all callbacks, referrals and administrative denials. Screen and handle voicemail and email daily. Support Administrative Assistant and PA/UM positions by processing requests for information, referral decision, administrative denials and answering incoming calls. Maintain confidentiality of review information and electronic and hard copy medical records in accordance with HIPAA regulations and AHG Policy. Respond to provider inquiry questions professionally and direct provider to appropriate resources. Educate provider regarding use of Gainwell Customer Service, GAMMIS, Medical Review Portal and Department of Community Health policies and procedures as needed. Participate in Quality Improvement activities and comply with departmental telephone monitoring guidelines. Other job functions: Work in close collaboration with other team members to support the development of new projects and the continuous improvement of the overall work of the team. Promote core values of teamwork, professionalism, effective communication skills and positive behavior. Maintain security and confidentiality of all information in accordance with HIPAA laws and regulations and company policies. Demonstrate compliance with company corporate and departmental policies as evidenced by attendance, punctuality, and dress. Perform other duties as assigned. Knowledge, Skills, and Abilities: Accurate grammar, spelling and filing skills. Strong organizational skills with ability to demonstrate the work priorities. Demonstrates ability to perform work with considerable independence by use of creative thinking, thorough analysis of problems, and use of innovative approaches to problem resolution. Excellent interpersonal, written, and verbal skills required. Excellent telephone skills, including ability to handle difficult calls/callers. Knowledge and skill in prioritizing, scheduling, coordinating work and managing multiple tasks and deadlines. Knowledge of administrative practices and procedures, and familiar with medical terminology and Medicaid program. Ability to travel by car or plane to Company locations, customer meetings or other locations as needed. Education, Experience, and Training: High School diploma or equivalent. One to five years related experience in general clerical duties and previous telephone or customer service experience required, preferably in a medical setting. Coding experience preferred. Alliant offers work/life balance and great benefits including medical, dental, life, disability, paid-time off, retirement with match and contribution, employee assistance program, parental leave, and more. Alliant Health Group and family of companies is an Equal Employment Opportunity Employer (EOE) and Drug Free Workplace. In compliance with the ADA Amendments Act (ADAAA), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. Please contact View phone number on click.appcast.io. #J-18808-Ljbffr Alliant Health Group