Care Review Processor

Job Description

Job Description

AltaStaff is a staffing agency currently looking for a  Care Review Processor for one of our Managed Care partners!

This is a full-time position that is fully remote, but candidates must reside in NY (outside greater NYC), FL, GA, MI, OH, WI, IA, NM, TX or KY

Pay : $23.00 - $25.00 hourly

Schedule : Monday-Friday, 9am-6pm EST after training. Training is 8am-5pm EST

Position Purpose : Reviewing and processing authorization requests, Conducting inbound / outbound calls to providers. Fax intake, process faxes submitted by providers and process the authorization requests.

Job Responsibilities :

Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate Health Care Services staff

Provide computer entries of authorization request / provider inquiries by phone, mail, or fax

Verify member eligibility and benefits

Provides telephone, clerical, and data entry support for the Care Review team

Provides computer entries of authorization request / provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes

Responds to requests for authorization of services submitted via phone, fax, and mail according to operational timeframes

Contact’s physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director

Job Qualifications :

HS Diploma or GED, Associates preferred.

2+ years of previous health admin experience

Previous health insurance background and Medicaid knowledge highly preferred

1-2+ years of experience in a Utilization Review Department and / or ICD and CPT coding

Previous Hospital or Healthcare clerical, audit or billing experience

Experience with Medical Terminology.

If you've applied and would like to view your application status, please visit :   https : / / altastaff.zenople.com / login / ALTA

AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

INDLP

#ZR