Review Assistant II

Telligen • West Des Moines, IA

127d

About The Position

This position is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services. This position is required to be in-office 2 days per week.

Requirements

• High school diploma or equivalent
• 2 years of experience working in a customer service or healthcare environment
• Demonstrated ability working with confidential information and in a deadline driven environment
• Excellent verbal and written communication skills and intermediate PC skills.

Nice To Haves

• Experience in a health care environment preferred.
• Satisfactory completion of medical terminology course preferred.
• Intermediate PC functions preferred.

Responsibilities

• Interprets review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates and communicating the authorization for requested services.
• Coordinates, distributes and tracks highly confidential medical information from multiple sources (fax, web, and phone).
• Interprets and adheres to URAC standards for assigned programs as well as federal and state requirements.
• Ensures quality customer service by responding to phone inquiries from members, physicians, and providers.
• Prioritizes workload to meet program or regulatory time frames.
• Provides verbal and written communications of review decisions to include administrative denials.
• Completes service/treatment screens for accurate transmission of outcome decision.
• Provides general office support and performs miscellaneous duties as assigned.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 501-1,000 employees