Health Services Assistant-ABQ

Presbyterian Healthcare Services•New York, NY

23h•Onsite

About The Position

Responsible for supporting Health Services Coordination functions including, but not limited to, medical records coordination, technical retrospective claims review, referral/auth. entry, research which may include but not limited to claims, eligibility, benefits, provider contracts, coordination of benefits, provider education, data entry report generation, act as liaison to and/or assists PHS clinical leaders.

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.
May respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements.
May conduct outbound calls as required and meet established quality/quantity guidelines supporting initiatives and/or programs.