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Care Review Processor

Integrated Resources, Inc

El Paso, Texas

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Access Authorization, Behavioral Health, Billing, CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing), Certified Case Manager (CCM), Computer Maintenance, Computer Skills, Current Procedural Terminology (CPT), Customer Support/Service, Data Entry, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, High School Diploma, Hospital, ICD-10, ICD-9, Internal Rate of Return (IRR), Long-Term Care, Managed Care, Medical Diagnosis, Medical Office, Medical Records, Patient Admissions, Patient Care, Provider Contracting, Quality Metrics, Request for Information (RFI), Utilization Management
LOCATION
El Paso, Texas
POSTED
2 days ago
Care Review ProcessorJob Title: Care Review ProcessorDuration: 4+ months contractLocation: Texas USA 79902Hours: Mon-Fri 8:00 AM to 5:00 PMTop Three Skill Sets: Customer Service, Computer Skills and medical terminologyJob Description:Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits, Determine provider contracting status and appropriateness, Determine diagnosis and treatment request Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), Determine COB status, Verify inpatient hospital census-admits and discharges, Perform action required per protocol using the appropriate Database.Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Client's operational timeframes.Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care.Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.Provide excellent customer service for internal and external customers.Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.Meet productivity standards.Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).EDUCATION:Accurate data entry at 40 WPM minimum.Required Education: High School Diploma/GEDRequired Experience: 1-4 years of experience in a Utilization Review Department in a Managed Care Environment.Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical TerminologyAdditional Information:All your information will be kept confidential according to EEO guidelines.

About the Company

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Integrated Resources, Inc