Overview

Collects specific data in the medical management information system for the clinical staff. Resolves authorization issues as well as troubleshoots, researches and resolves related issues in a timely and efficient manner. Works under general supervision.

Compensation Range:$20.98 - $26.23 Hourly

• Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools. • Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication. • Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved. • Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions. • Provides triage and management of calls ensuring that established call performance targets are consistently achieved. • Provides feedback to leadership regarding training needs • Collaborates with management to determine the best approach to service customers, handle repeat vendor issues and other job-related matters to maximize and improve delivery, billing and payment of goods and services. • Protects the confidentiality of member information and adheres to company policies regarding confidentiality. • Participates in special projects and performs other duties as assigned.

Qualifications

Education:
High School Diploma or equivalent Required

Work Experience:
Minimum of two years of experience in a customer service role Required Excellent oral and written communication skills Required Advanced personal computer skills, including Word, Excel or Access Required Utilization Management experience Preferred