Nationwide firm works with outside providers, members, internal providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Our staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Remote: Yes, 100%

Knowledge/Skills/Abilities

• Provides telephone, clerical and data entry support for the Care Review team.

• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

• Responds to requests for authorization of services submitted via chat, phone, fax and mail according to operational timeframes.

• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

Minimum Job Qualifications

Required Education – HS Diploma or GED

Required Experience – 1-3 years experience in an administrative support role

Preferred Education – Associate’s Degree or equivalent exp. 

Preferred Experience – 3+ years experience in an administrative support role