Health Services Assistant

Presbyterian Healthcare Services • New York, NY

21d • $17 - $25 • Onsite

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Health Services Assistant to join our team.

Requirements

• High School Diploma GED required.
• One to three years' experience in a medical or health insurance position

Nice To Haves

• Associates Degree or completion of a medical vocational program preferred.

Responsibilities

• Prior Authorization may process emergent/elective and transitional prior authorization requests according to established evidenced based criteria.
• Screens prior authorization requests not meeting guidelines and requests/gathers/forwards additional information.
• May conduct utilization review by monitoring daily prior authorization requests and documenting timely updates for service requests.
• Completes Administrative Denials and submits Medical Director Reviews as directed.
• Correspondence with Provider/Member Notifies members and providers including but not limited to approvals, provider notification of service requests and out of network approvals
• Coordination of Benefits by monitoring benefit limitations for all members.
• Identifies members for case management or needed follow up regarding subrogation or coordination of benefits.
• Refers to appropriate departments as needed.
• Provides claims follow up as indicated.
• Documents in multiple computer applications timely and according to unit policy and regulations.
• Documents appropriate codes and claims payment information to ensure accurate claims payment.
• Data entry to ensure accurate records notifications/referrals.
• Submits Patient referrals for complaints and compliments.
• Liaison with providers and facilities telephonically, include problem solving regarding member needs.
• Requests clinical updates.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees