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    Intake Care Senior Representative - Houston, United States - Tailored Management

    Tailored Management
    Tailored Management Houston, United States

    4 weeks ago

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    Description
    Job descriptionJob Title: Intake Care Senior RepresentativeLocation: 100% Remote Pay Rate: $ HR
    Contract: 11/28/ /10/2023
    Hours of Operations:
    Monday - Friday ; some flexibility ; call centers open between 7am - 7pm (CST)
    100% Remote - candidates must have reliable high speed internet connection and work CST hours
    Position Summary:
    The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization. The Pre-cert Specialist will communicate with internal and external providers regarding authorization status.
    Essential Duties and Responsibilities:
    • Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal
    • Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
    • Determine authorization requirements based on company policy, member benefit grid and provider status
    • Review customer coverage and benefits
    • Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse)
    • Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
    • Professional demeanor and the ability to work effectively within a team or independently
    • Flexible with the ability to shift priorities when required
    • Maintains regular and acceptable attendance in accordance with Time Away From Work policy
    • Ability to work evening, weekend and holiday shifts to support Utilization Management
    • Other duties as requested
    Qualifications:
    • 1+ yrs experience in a managed care environment
    • Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
    • Effective oral and written communication skills
    • Strong customer orientation
    • Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
    .
    Knowledge, Skills, Abilities Required:
      • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer
      • Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment
      • Proficient knowledge of departmental policies and procedures
      • Knowledge of Medicare Regulatory Requirements
      • Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
      • Effective oral and written communication skills
      • Strong customer orientation
      • Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
    • 1+ yrs experience in a managed care environment required
    Education
    Highschool Diploma or GED Required
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