Care Review Processor

Job Title : Care Access and Monitoring (CAM) Data Entry Specialist

Location : Remote – Must reside in one of the following states : AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI

Schedule : Monday – Friday, 8 : 30 AM – 5 : 00 PM CST (must be able to work PST hours as needed)

Flex Time : Ability to work late hours, weekends, and holidays when required

Required Equipment :   laptop, two monitors, keyboard, mouse, headset

Job Summary :

Join our Care Access and Monitoring (CAM) Team as a Data Entry Specialist to provide critical support in processing healthcare service authorizations. This role involves verifying eligibility, entering and updating data, and ensuring seamless communication between healthcare providers and our client’ s members. If you have strong attention to detail, can multi-task efficiently, and adapt quickly to changing environments, we encourage you to apply!

Key Responsibilities :

• Enter authorization requests and provider inquiries via phone, mail, and fax.
• Verify member eligibility, benefits, and provider contracting status.
• Identify diagnoses and treatment requests and assign appropriate billing codes (ICD-9 / ICD-10, CPT, HCPC).
• Confirm coordination of benefits (COB) and inpatient hospital admissions and discharges.
• Process requests following our client’ s operational timeframes and compliance guidelines.
• Communicate with healthcare providers to request missing or additional information.
• Notify Care Access and Monitoring Nurses and Case Managers of hospital admissions or changes in member status.
• Ensure data confidentiality and compliance with HIPAA regulations.
• Participate in team meetings, quality assurance reviews, and training sessions.

Minimum Qualifications :

Strong  computer skills  and proficiency in  Microsoft Office.

Excellent  attention to detail  and ability to  multi-task.