Care Review Processor I
Reference Code: 4618
Position Title: Care Review Processor I
Location: REMOTE, El Paso TX 79902, San Antonio TX 78216, or Irving TX 75038
Duration: 3 months with possible extension
Comments for Suppliers:
- This is a Monday through Friday schedule.
- Position begins as a remote position due to the pandemic.
- Once the pandemic resolves, the person may be required to return to the nearest UM office – San Antonio, El Paso, or Irving, TX.
- Same team as REQ 14220, however different Hiring Manager
- Candidates must be located in/near once of the following locations: El Paso, San Antonio, or Irving, TX
- The position will start as a remote position due to the pandemic, but staff may be required to return to the nearest office in El Paso, San Antonio, or Irving, TX once offices reopen.
- Must have requirements for the position: Data entry, ICD10/HCPCS/CPT code knowledge, 1-2 years experience in healthcare insurance or provider front office, work well independently, utilize multiple computer applications simultaneously
- Day to day responsibilities: Staff member will review prior authorization requests, create prior authorizations with the system, make phone calls to providers to clarify requests or obtain missing information. Process prior authorization requests for medical services for Texas members.
- 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 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.
Required Education: HS Diploma or GED
Required Experience: 1-3 years experience in an administrative support role in healthcare.
Preferred Education: Associate's Degree
Preferred Experience: 3+ years experience in an administrative support role in healthcare, Medical Assistant preferred.