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Clinical Support Representative

LanceSoft Inc

Atlanta, GA

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Adjudication Systems, Case Management, Claims Processing, Clinical Support, Current Procedural Terminology (CPT), Customer Support/Service, Electronic Medical Records, Healthcare Common Procedure Coding System (HCPCS), ICD-9, Medical Coding, Medical Terminology, National Committee for Quality Assurance (NCQA), Product Planning, Quality Assurance, Record Keeping, Regulations, Telephone Skills, Utilization Review Accreditation Commission (URAC)
LOCATION
Atlanta, GA
POSTED
30+ days ago
Engagement Description: The Clinical Support Representative’s primary responsibility is to facilitate and coordinate preadmission/admission reviews, prior approvals and referral requests through the medical review cycle in compliance with Rule 10, DOL (department of labor), NCQA (National Committee for Quality Assurance), and URAC (Utilization Review Accreditation Commission) timeliness requirements. This includes generating and performing quality assurance of correspondence, entering authorizations to ensure appropriate claims processing, and maintaining electronic medical records. The Clinical Support Representative is also responsible for answering department phone calls and evaluating issues and questions from internal and external customers. The Representative provides exceptional customer service when interacting with all internal and external customers and always maintains the highest level of confidentiality. Top 3 Required Skills/Experience: Understanding of plan benefits and products Understanding of claims adjudication and data systems Understanding of medical terminology and medical coding, to include ICD-9, HCPCS, and CPT4 Understanding of URAC, NCQA, Rule 10, DOL, and other regulatory standards pertaining to Case/Care Management

About the Company

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LanceSoft Inc

We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc). 

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.

COMPANY SIZE
2,000 to 2,499 employees
INDUSTRY
Staffing/Employment Agencies
FOUNDED
2000
WEBSITE
http://www.lancesoft.com/

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