About the Role:

• We are looking for a detail-oriented individual to join our Care Access and Monitoring (CAM) team.
• The role involves providing clerical and data entry support for client Members who require hospitalization and/or utilization review for other healthcare services.
• The position is 100% remote and candidates must be located in one of the following 15 states: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI. The role requires working in PST time zone.

Responsibilities: -

• Verify member eligibility and benefits
• Determine provider contracting status and appropriateness
• Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes)
• Respond to authorization requests via phone, fax, and mail
• Contact physician offices for missing information
• Provide excellent customer service for internal and external customers
• Maintain confidentiality and comply with HIPAA
• Participate in team meetings and interdepartmental collaboration
• Meet productivity and quality standards

Education Qualification:

• Prefer Healthcare and Medical Terminology experience.
• UM and Prior Authorization experience is a plus.

Required Skills: -

• Strong communication and problem-solving skills
• Working knowledge of medical terminology and abbreviations
• Ability to think analytically and problem solve
• Good interpersonal and team skills
• High regard for confidential information
• Ability to work independently and as part of a team
• Proficient in MS Office software
• Accurate data entry at 40 WPM minimum