Case Review Specialist - PR

OncoHealth•Guaynabo, PR

53d•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
Fully Bilingual (English and Spanish)
A minimum of 2-4 years' administrative experience and/or customer service or relevant educational attainment required
Implementation of systems for program effectiveness and productivity required
Systems/Tools: MS Office Suite proficient

Nice To Haves

Remote work experience is preferred
Knowledge in pre-authorizations and health insurance client services departments are preferred

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 - 5:00 pm EST with On-call Sundays (Office hours may change/extend upon operational needs)
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
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

Benefits

We offer a full benefit package on your first day, along with a company bonus.
You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter.

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