Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care.
Education Level : High School Diploma
3 years experience in health care claims / service areas or office support.
Requirred Medical back ground, computer skills, medical terminology, claims and service office support, CPT and ICD-10 coding
Preferred Qualifications :
Two years' experience in health care / managed care setting or previous work experience
Knowledge of CPT and ICD-10 coding.
Knowledge, Skills and Abilities (KSAs)
Ability to effectively participate in a multi-disciplinary team including internal and external participants., Proficient
Excellent communication, organizational and customer service skills. , Proficient
Knowledge of basic medical terminology and concepts used in managed care., Proficient
Knowledge of standardized processes and procedures for evaluating medical support operations business practices., Proficient
Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy. , Proficient
Ability to pay atte
ntion to the minute details of a project or task, Proficient
Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point, Proficient
ESSENTIAL FUNCTIONS :
35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
35% Reviews authorization requests for initial determination and / or triages for clinical review and resolution.
20% Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
10% Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
Thanks & Regards,
LAXMAN
KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
Tel : (240) 800-0039 |Email : lax@kmmtechnologies.com
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