Review Assistant - Bilingual (Remote)

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

5d•Remote

About The Position

Acentra Health is looking for a Review Assistant Bilingual to join our growing team. The Review Assistant role is pivotal in streamlining the clinical review process by meticulously preparing prior authorization cases. This role primarily supports non-clinical review operations, with bilingual translation services provided as an integrated secondary function. This individual will uphold a comprehensive understanding of internal policies, procedures, and services, ensuring adherence to organizational standards. Their attention to detail and dedication to efficiency are expected to make a significant contribution to review operations' success.

Requirements

High school diploma or GED equivalent.
1+ years of experience in administrative or records management.
2+ years in an administrative support or customer service position and be familiar with health care.
Bilingual proficiency in English and Spanish (verbal and written) required, with the ability to accurately translate administrative and healthcare-related information and with ability to meet organizational language proficiency standards through validated testing (e.g., ACTFL or equivalent).
Proficiency in Microsoft Office applications and Excel, ensuring efficient utilization of essential software tools.

Nice To Haves

Associate degree
Comprehensive knowledge of office environments and business processes.
Understanding of a customer service approach tailored for medical provider stakeholders.
Familiarity with government structures and related programs is advantageous.
Excellent communication skills.
Ability to multitask, prioritize, and provide service to a diverse range of customers.
Experience in development and project activities.
Experience in staff and provider training, with preferred public speaking skills.
A proactive approach to continually assess office functions and report potential issues to the Director.
Capability to track provider issues and report them appropriately.
Willingness to learn the Atrezzo application and assist customers in resolving technical issues related to the submission of Health Homes authorization requests.

Responsibilities

Provide primary non-clinical program support by encompassing provider training, customer service, call triaging, authorization preparation, data entry, and the development and tracking of functions for members and providers.
Offer non-clinical support to other programs as needed, ensuring flexibility and adaptability in meeting organizational requirements.
Review patient records for completeness against submission requirements, identifying cases requiring additional non-clinical information.
Process and document case discharges with precision and timeliness.
Ensure accurate and prompt submission of all administrative-related documents to relevant parties.
Act as a liaison with internal and external customers, fostering positive and professional relationships to facilitate an effective review process.
Attend training and scheduled meetings, maintaining up-to-date information for case preparation.
Uphold medical records confidentiality through proper use of computer passwords and secured files, adhering to HIPAA policies.
Answer calls and demonstrate proper telephone etiquette and communication skills in alignment with Acentra Health's policies, procedures, and guidelines.
Cross-train to perform duties of other contracts within the Acentra Health network, contributing to a flexible workforce to meet client/consumer needs.
Fulfill other assigned duties to meet contract deliverables and organizational requirements.
Review, validate, and support Spanish-language member-facing communications including determination letters, denial letters, appeal correspondence, and authorization-related documentation to ensure accuracy, consistency, clarity, and appropriate healthcare terminology in both English and Spanish.
Identify and correct translation inconsistencies, grammatical issues, formatting concerns, and language discrepancies across bilingual member communications and departmental documentation.
Maintain consistency in terminology, formatting, tone, and messaging across bilingual communications and departmental documentation.
Bilingual responsibilities are non-clinical in nature and limited to administrative, operational, and customer service support, not clinical decision-making or interpretation of medical necessity.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.