Position Description: ROLE AND RESPONSIBILITIES
Communication with Providers regarding Pre-Authorization Requests.
Provider Outreach Calls to retrieve Medical Records.
Maintaining HIPAA Compliant Practices, liaison between Members & Providers.
Full review of member medical records to aid in determination of Share Requests.
Knowledge, and application of HealthShare Programs. Full understanding and comprehension
Review, and identify any prior hospitalizations, procedures, advanced imaging.
Identifying Pre-Existing Conditions in Member Medical Records.
Member Calls to Discuss any additional records, or information as needed.
Work Effectively, and Efficiently with Member/Provider Relations Team, for Final Dispositions.
QUALIFICATIONS AND EDUCATION REQUIREMENTS
REQUIRED, LPN., RN., MA. Minimum of two (2) Years of Healthcare, Insurance, or HCSM Experience. High School Diploma: Degree and/or Certification.
PREFERRED SKILLS
Effective and Clear Verbal and Written Communication, Active Listener, Conflict Management, Strong attention to detail, Organizational Skills, Time Management, Strong ability to multi-task. Must be a self-starter, and Team Player. Proficient in Microsoft Office Applications with heavy emphasis on Excel. Additional training is provided for programs used for processing needs.