Health Services Assistant

Presbyterian Healthcare Services • New York, NY

3d • $17 - $25 • Onsite

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Health Services Assistant to join our team. The Health Service Assistant is 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. Some key responsibilities include: 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.

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

• 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
• 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: Part-time
• Career Level: Entry Level
• Education Level: High school or GED