Tailored Management

Monday - Friday ; some flexibility ; call centers open between 7am - 7pm (CST). 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.. Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse). Ability to work evening, weekend and holiday shifts to support Utilization Management. Proficient in medical terminology, CPT, HCPCS and ICD-10 coding

senior representative

Job description Job Title: Intake Care Senior RepresentativeLocation: 100% Remote Pay Rate: $ 15.01-27.51 HR Contract: 11/28/2022- 02/10/2023 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: <ul> <li>Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal </li> <li>Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate) </li> <li>Determine authorization requirements based on company policy, member benefit grid and provider status </li> <li>Review customer coverage and benefits </li> <li>Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse) </li> <li>Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization. </li> <li>Professional demeanor and the ability to work effectively within a team or independently </li> <li>Flexible with the ability to shift priorities when required </li> <li>Maintains regular and acceptable attendance in accordance with Time Away From Work policy </li> <li>Ability to work evening, weekend and holiday shifts to support Utilization Management </li> <li>Other duties as requested </li> </ul>Qualifications:<ul> <li>1+ yrs experience in a managed care environment </li> <li>Proficient in medical terminology, CPT, HCPCS and ICD-10 coding </li> <li>Effective oral and written communication skills </li> <li>Strong customer orientation </li> <li>Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word </li> </ul>. Knowledge, Skills, Abilities Required: <ul> <li> <ul> <li>Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer </li> <li>Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment </li> <li>Proficient knowledge of departmental policies and procedures </li> <li>Knowledge of Medicare Regulatory Requirements </li> <li>Proficient in medical terminology, CPT, HCPCS and ICD-10 coding </li> <li>Effective oral and written communication skills </li> <li>Strong customer orientation </li> <li>Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word </li> </ul> </li> <li>1+ yrs experience in a managed care environment required </li> </ul> Education Highschool Diploma or GED Required

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