Clinical Information, Communication Skills, Current Procedural Terminology (CPT), Customer Support/Service, Establish Priorities, Fax Machines, Health Plan, Healthcare, Medical Treatment, Metrics, Microsoft Office, Microsoft Product Family, Multitasking, Patient Care, Presentation/Verbal Skills, Risk, Social Work, Team Player, Telephone Triage, Voice Mail, Writing Skills
Charlestown, MA, MA(remote)
Pay Rate: $20 per hour
Summary:
- Shift Schedule: 8:30 AM – 5:00 PM Monday – Friday
- Work Mode: Remote
Responsibilities:
- Prioritizes incoming Prior Authorization requests received from faxes and the provider portal.
- Processes incoming requests, including authorizing specified services, as outlined in departmental policies, procedures, and workflow guidelines.
- Requests clinical information and outreaches to providers for missing information.
- Refers authorization requests that require clinical judgment to Prior Authorization Clinician, Supervisor, or Medical Director.
- Meets or exceeds position quality, quantity, and data metrics and turnaround timeframes.
- Supports Prior Authorization Clinicians.
- Answers ACD line calls, verifies member eligibility, and enters information necessary to document the caller’s request in Jiva.
- Triages calls and forwards to appropriate departments.
- Identifies and informs callers of network providers, services, and available member benefits.
- Maintains thorough understanding of services requiring authorization through use of the Plan’s CPT code lookup tool and policies.
- Engages in professional communications, following department protocols for opening and closing the call and leaving messages.
- Informs provider of decision per department procedure.
- Coordinates resolution of escalated member or provider inquiries as related to Prior Authorization.
- Works with providers and key departments to promote an understanding of Prior Authorization requirements and processes.
- Maintains general understanding of applicable sections of member handbooks, evidence of coverage, Health Trio functionality, and WellSense website.
- Participates in team operational activities, including but not limited to handling primary responsibilities for triage function and department voicemail coverage.
- Meets organizational standards for assuring member and provider communications are accurately sent to appropriate recipients.
- Other duties as assigned.
Requirements:
- Associate’s degree in healthcare, Social work or related area, or the equivalent combination of training and experience is required.
Preferred Skills:
- Bachelor’s Degree.
- Minimum three years of experience in medical practice administrative position.
- Experience with Jiva, FACETS, or other healthcare databases.
- Experience with Health Plan Utilization and Customer Service.
- Ability to prioritize and manage multiple tasks in a fast-paced environment within turnaround timeframes.
- Ability to process high volume of requests and meet performance targets with a 95% or greater accuracy rate.
- Sense of urgency.
- Strong customer service skills.
- Effective collaboration skills that work well in a team setting.
- Strong listening, oral and written communication skills.
- A strong working knowledge of Microsoft Office products.
Benefits:
- Work is performed fully remotely.
- No or very limited physical effort required. No or very limited exposure to physical risk.
- Regular and reliable attendance is an essential function of the position.
A
Axelon Services Corporation