Employees are permitted to live in approved states which include AL, AZ, AR, CO, FL, GA, ID, IN, IA, KS, KY, LA, MD, MI, MS, MO, NC, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, or WY.
Job Detail
Job Description
Duties:
• Process a variety of requests, inquiries and transactions via phone, email, fax, and mail
• Review requests to ensure accuracy
• Support internal & external customers via phone or email
• Document all pertinent information related to the call/inquiry, attach supporting information as applicable and if unable to resolve route to appropriate area for follow up as applicable
• Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process
• Screen inquiries to determine if authorization is required
• Verify member benefits and eligibility and/or provider setup.
• Maintain and update Service Requests and research incorrect or missing information.
• Triage and assign all incoming inquiries in a timely, efficient manner throughout the day to appropriate staff
• Perform Peer Audits monthly as required
• Provide clinical review outcome notification to members and providers (verbal and written)
Requirements:
• High school diploma or GED
• 3+ years of experience in related field.
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