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Job Description
- Identify, sort, and route a high volume of requests received via fax, online, mail, or phone inquiries and process requests from each.
- Perform high level of data entry.
- Demonstrate a high level of critical thinking and detail orientation.
- Review all referral and preauthorization requests for accuracy and completeness.
- Secure patient demographics, verify benefits, and request and enter clinical history as needed.
- Ensure the overall data integrity of documents received and entered into computer system.
- Provides timely oral and/or written notification of determination to provider and member
- Thoroughly documents all case notes in Care Management software
- Assist in administrative and data entry function as needed pertaining to UM functions, customer service and care management.
- Ensure the overall data integrity of documents received and entered into computer system
- Responsible for following non-clinical algorithms, network tier structure/exceptions and preauthorization requirement by health plan for initial preauthorization of services.
- Responsible for following all compliance and regulatory requirements for turn-around time, notification to provider/member, and accuracy/completeness
- Responsible for processing all Out of Preferred Network and Out of Network (OOPN / OON) requests, inclusive of the redirection process and preparation of denials.
- Supports UM Clinical staff in obtaining clinical information, status of requests, and status of admission/discharge.
- Handle a high level of inbound and outbound phone calls with excellent customer service
- Be responsible for meeting telephone system metrics set by the health plan to include length of call, length of answer time and number of calls taken within a specific period.
- Responsible for supporting any assigned special projects pertaining to UM functions, customer service, and care management.
- Consistently meets performance standards of production, accuracy, completeness and quality.
- Communicate actively and routinely with management team, and staff in handling client services, issues, escalated referral and preauthorization questions.
- Use interpersonal/communication strategies with individuals to achieve: (a) desirable/acceptable outcomes/responses (b) perceptions of satisfaction or acceptance of those involved.
- Comply with established Silverback procedures and personnel policies.
- Perform procedures required by the assignment: (a) safely, without causing harm (b) effectively, achieving the intended outcome/result (c) efficiently, using the fewest possible resources (d) legally, within the scope of practice/policy
- Establish and/or revise priorities based on: (a) urgency of the patient or organization’s need (b) resource availability (c) predetermined schedules (d) other departments/personnel expectations.
Qualifications
- High School Diploma
- 3 years of experience with payroll/accounting functions or appropriate college coursework or vocational/technical training may substitute at an equivalent rate for the required experience
- Strong written and verbal communication skills (Additional languages preferred)
- Must have working knowledge of state and federal payroll tax requirements and be familiar with regulations governing taxable income and wage reporting requirements
Additional Information
Compensation/Benefits:- Competitive wages
- Weekly pay
- Medical, Dental & Vision Coverage – Available 1st of the month following 30 days of employment
- Health Savings Accounts (HSA)
- Flexible Spending Accounts (FSA)
- Voluntary Short Term & Long Term Disability
- Employee Assistance Program (EAP)
- 401(k) retirement plan
- Paid Time Off (PTO)
- 7 Company Paid Holidays
- 100% Company Paid Life Insurance
- Voluntary Life Insurance
- Accident, Hospital, and Critical Illness Insurance
- Identity Theft Protection Plan
- Discounted Legal Care Plan
- ID: #23354724
- State: Texas San antonio 78201 San antonio USA
- City: San antonio
- Salary: USD TBD TBD
- Job type: Full-time
- Showed: 2021-11-23
- Deadline: 2022-01-22
- Category: Et cetera