Client Services Analyst

A company is looking for a Client Services Analyst I who will manage prior authorization and referral requests for Medicaid members.

Key Responsibilities

Process prior authorization and referral requests, ensuring accuracy and compliance with medical necessity documents

Validate requests based on policies and guidelines, identifying discrepancies for further investigation

Monitor processing activities to adhere to legal and regulatory requirements, updating systems with patient information

Required Qualifications

Experience in processing prior authorization and referral requests in a healthcare setting

Proficient in interpreting EOB and UB-04 claim forms, with knowledge of medical coding (CPT, HCPCS, ICD-10)

Familiarity with insurance payers and Medicaid policies

Strong analytical skills for data accuracy and issue resolution

Proficient in Microsoft Excel, Visio, and PowerPoint