Position Wanted

Role is supporting General State and Commercial and Behavioral State and Commercial.

JOB DESCRIPTION

• 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)

Hiring Requirements

• High school diploma or GED

• 3+ years of experience in related field.