Care Review Processor I - Columbus, OH
5 days ago
Job Summary
Building case prior authorization requests for members and heavy data entry making phone calls out to doctors hospitals etc.
Responsibilities
- Temp for 90 days no possibility of going permanent M-F 8 am to 5 pm no OT Building case prior authorization requests for members Heavy data entry and making phone calls out to doctors hospitals etc Medical background prior authorization experience A minimum of 1-2 years experience Knowledge of ICD 10 codes or CPT codes Computer literate Strong customer service skills with pleasant phone voice Microsoft Excel beginner level Works within the Care Access and Monitoring CAM team to provide clerical and data entry support for Members that require hospitalization and/or utilization review for other healthcare services Checks eligibility verifies benefits obtains enters data into systems processes requests triages members information appropriate Health Care Services staff ensure delivery high quality cost-effective healthcare services according State Federal requirements achieve optimal outcomes Members Provide computer entries authentication request provider inquiries by phone mail fax Including verify member eligibility benefits determine provider contracting status appropriateness Determine diagnosis treatment assign billing codes ICD-9/ICD-10 CPT/HCPC codes Verify inpatient hospital census-admits discharges Perform action required protocol using Database Respond requests authentication services submitted CAM via phone fax mail operational timeframes Participates interdepartmental integration collaboration enhance continuity care members including Behavioural Health Long Term Care Contact physician offices Department guidelines request missing information authentication requests additional information requested Medical Director Provide excellent customer service internal external customers Meet department quality standards including inter-rater reliability testing quality review audit scores Notify Care Access Monitoring Nurses case managers hospital admissions changes member status Meet productivity standards Maintain confidentiality comply Health Insurance Portability Accountability Act HIPAA Participate Care Access Monitoring meetings active member team Meet attendance guidelines Healthcare policy Follow standards conduct guidelines described Healthcare HR policy Comply workplace safety standards
- Provide excellent customer service internal external customers Meet department quality standards including inter-rater reliability testing quality review audit scores Notify Care Access Monitoring Nurses case managers hospital admissions changes member status Meet productivity standards Maintain confidentiality comply Health Insurance Portability Accountability Act HIPAA Participate Care Access Monitoring meetings active member team Meet attendance guidelines Healthcare policy Follow standards conduct guidelines described Healthcare HR policy Comply workplace safety standards
Job description
, consectetur adipiscing elit. Nullam tempor vestibulum ex, eget consequat quam pellentesque vel. Etiam congue sed elit nec elementum. Morbi diam metus, rutrum id eleifend ac, porta in lectus. Sed scelerisque a augue et ornare.
Donec lacinia nisi nec odio ultricies imperdiet.
Morbi a dolor dignissim, tristique enim et, semper lacus. Morbi laoreet sollicitudin justo eget eleifend. Donec felis augue, accumsan in dapibus a, mattis sed ligula.
Vestibulum at aliquet erat. Curabitur rhoncus urna vitae quam suscipit
, at pulvinar turpis lacinia. Mauris magna sem, dignissim finibus fermentum ac, placerat at ex. Pellentesque aliquet, lorem pulvinar mollis ornare, orci turpis fermentum urna, non ullamcorper ligula enim a ante. Duis dolor est, consectetur ut sapien lacinia, tempor condimentum purus.
Access all high-level positions and get the job of your dreams.
Similar jobs
Lab Services Technician-IRP-East Laboratory
1 month ago
The East Clinical Laboratory encompasses specimen processing and testing services within the Department of Clinical Laboratories including client services and all areas within the Rapid Response Laboratory. · The laboratory is staffed 24 hours per day, including Saturday and Sund ...
Lab Services Technician-IRP-East Laboratory
1 month ago
The medical laboratory technician-processor (MLT-Processor) is responsible for covering the duties and responsibilities of the Central Processing area and/or Microbiology processing area within the department of Clinical Laboratories. · Performs specimen processing, manual comput ...
Lead, Card Network
5 days ago
The Lead Card Network position at UMB Bank involves managing relationships with card networks and processors to ensure successful implementation and compliance with Visa, Mastercard rules. · ...
Home Equity Loan Processor
5 days ago
The Home Equity Loan Processor is responsible for processing all home equity loan applications accurately and within established timelines. The processor acts as a liaison during the home equity process working directly with the Telhio loan officer and borrower to obtain all nece ...
Escrow Processing
1 month ago
This is a full-time Escrow Processing role located in Columbus, OH. The Escrow Processor will handle various tasks including reviewing title documents, preparing escrow files and collaborating with clients. · ...
Senior Loan Processor
1 month ago
We are seeking an experienced Senior Loan Processor to manage residential mortgage files from application through clear to close. · Review each loan file to verify that documents are present, accurate and complete before underwriting · Manage loan process through mortgage softwar ...
File Credit Reviewer
1 month ago
We're making homeownership easier and more accessible than ever. As a mission-driven fintech, we simplify the home-buying process through cutting-edge technology and a seamless customer experience. · ...
Student Assistant
1 week ago
The radiology student assistant assists the technical staff, clerical staff, physicians, patients and visitors within the Department of Radiology with patient care and transportation... · ...
Bilingual Loan Officer Assistant
1 month ago
Take a look at Equity Resources We are a fun and friendly environment where we work together to meet our daily goals. · We are a family owned company that recognizes your contributions and has a philosophy of no layoffs during the down-season. · Our goal and purpose is to Improve ...
Mortgage Loan Underwriter Senior
3 weeks ago
The role of the Underwriter III is to evaluate the credit risk against company standards and to determine the borrower's ability to repay a residential mortgage.The Underwriter III analyzes and interprets the most complex financial and non-financial data decisioning the requests ...
OH Operations Support
3 weeks ago
The Mortgage Processor is responsible for managing the loan application process from start to finish. · This includes verifying applicant information, collecting required documentation, · ensuring compliance with lending guidelines, · and coordinating communication between borrow ...
Escrow Processor
1 month ago
We're a team of technologists and real estate experts passionately delivering transparency, ease and equity to this outdated industry. Our mission is to make it easy to buy and sell real estate. · We are deeply connected making the closing process fair transparent empowering us g ...
Full time Business Analyst with Credit Card Migration Experience out of Columbus OH. · ...
Financial Reporting Analyst
1 month ago
Join a team where your analytical strength and attention to detail directly influence the financial narrative of Worthington Steel. · ...
Consumer Loan Processor
1 month ago
The Consumer Loan Processor is responsible for providing the diligence required to complete the process for consumer loans. · Ensures accuracy for all consumer loans by auditing file, preparing loan checklists,ensuring system set-up is accurate, · verifying all required informati ...
Consumer Loan Processor
1 week ago
The Consumer Loan Processor is responsible for providing diligence required to complete process for consumer loans. · Duties include ensuring accuracy of all consumer loans by auditing file preparing loan checklists verifying system set up is accurate verifying all required infor ...
Clinical Psychologist
1 month ago
We are seeking a dedicated Clinical Psychologist to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process. · Conduct in-person disability assessments for U.S. Veterans. · Review and analyze electronic medical records via ...
Cash Processor-Warehouse
1 month ago
We believe in building partnerships that secure commerce and doing that requires fostering an engaged culture that values people with different backgrounds, ideas, and perspectives.We build a sense of belonging so all employees feel respected safe valued and we provide equal oppo ...
Sr. Financial Reporting Analyst
1 month ago
Join a team where your analytical strength and attention to detail directly influence the financial narrative of Worthington Steel. · In this Sr. Financial Reporting Analyst role, you'll dive into SEC reporting, partner with auditors, tackle technical accounting challenges, · and ...
Escrow Processing
1 month ago
This is an on-site Escrow Processing role located in Columbus, OH. · ...