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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.
Primary Responsibilities : This is a production role and you will have the responsibility to meet production, quality and regulatory expectations 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 case As needed, make outbound calls to providers to coordinate provider availability in treating members Other duties as assigned by manager and / or director 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 UnitedHealth Group policies and standards Remote but MUST live in a location that can receive a dedicated hard-wired high-speed internet connection or leverage an existing high-speed internet service provider (ISP) (minimum speed 1.
Last updated : 2024-06-22
Full Time
IT Outsourcing & Consulting
$33k-43k (estimate)
06/24/2024
09/20/2024
wipro.com
EAST BRUNSWICK, NJ
500 - 1,000
2013
Private
ABIDALI NEEMUCHWALA
$1B - $3B
IT Outsourcing & Consulting
Wipro Ecoenergy provides retrofitting and energy management services for defense, retail and telecommunication industries.
The job skills required for Call center agent include Customer Service, Problem Solving, Microsoft Office, Back Office, Computer Systems, Administrative Support, etc. Having related job skills and expertise will give you an advantage when applying to be a Call center agent. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Call center agent. Select any job title you are interested in and start to search job requirements.
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Call center agents are at the frontline of providing solutions to customers’ problems.
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Manage difficult customer situations and transfer calls to appropriate persons when necessary.
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A call center agent performs a number of functions that are more than just picking up calls.
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