Job Description

Contract: Pennington, New Jersey, US

Salary: $19.00 Per Hour

Job Code: 334644

End Date: 2023-06-04

Job Status: Expired

Roles and Responsibilities:

Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
Prepare, document, and route cases in the appropriate system for clinical review.
Initiates callbacks and correspondence to members and providers to coordinate and clarify benefits.
Upon completion of inquiries initiate a call back or correspondence to Physicians/Members to coordinate/clarify case completion.
Reviewing professional medical/claim policy-related issues or claims in pending status. Collection of clinical and non-clinical information, MCC can authorize services based upon scripts or algorithms used for pre-review screening

Required Skills:

Requires knowledge of medical terminology.
Prefer knowledge of contracts, enrollment, billing & claims coding/processing. Prefer knowledge of Managed Care principles.
Prefer 1-2 years of customer service or a medical support-related position.
Prefer the ability to use a personal computer and applicable software and systems.
Prefer the ability to analyze and resolve problems with minimal supervision.
Prefer knowledge of contracts, enrollment, billing & claims coding/processing

Recruiter

Phone

Divyani Balone

divyani.balone@collabera.com

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