Case Review Specialist - Atlanta

OncoHealth•Atlanta, GA

10h•Hybrid

About The Position

The Case Review Specialist ensures that case documentation is provided by the provider for accurate and timely determinations and communicates with clinical and non-clinical staff to facilitate case discussions.

Requirements

Bachelor’s Degree or relevant experience preferred
Experience working remote independently
A minimum of 2-4 years’ administrative experience and/or customer service or relevant educational attainment required
Knowledge in pre-authorizations and health insurance client services departments are preferred
Implementation of systems for program effectiveness and productivity required
Systems/Tools: MS Office Suite proficient
Reside within 25 miles of the Atlanta office, 7000 Central Parkway, Suite 1750, Atlanta, GA 30328
Reliable personal transportation
Ability to be in the office as required, but not limited to the following situations: Personal power outages, internet disruptions, natural disasters, and to process incoming Prior Authorization requests received via mail from Providers and Members

Responsibilities

Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 6 pm EST (Office hours may change/extend upon operational needs)
Periodic on-call responsibilities having availability during the week to travel to the Atlanta, GA office with personal transportation
Process cases and request/maintain clinical documentation and transmit timely determinations via the company’s internal system and/or by phone to the provider and/or member and/or payer, including mailed-in requests from providers and members
Intake Pre-Authorization requests and/or inquiries on existing pre-authorizations via phone, email, fax or by the portal and ensuring they are responded/processed within the established metrics
Work collaboratively with clinical and non-clinical staff to facilitate case discussions
Fax intake and labeling on weekends/Holidays as needed