Review Assistant II

Telligen • West Des Moines, IA

13d

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. What you'll do: Interpret 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. Coordinate, distribute and track highly confidential medical information from multiple sources (fax, web, and phone). Interpret and adhere to URAC standards for assigned programs as well as federal and state requirements. Ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames. Provide verbal and written communications of review decisions to include administrative denials. Complete service/treatment screens for accurate transmission of outcome decision. Provide general office support and perform miscellaneous duties as assigned.

Requirements

• High school diploma or equivalent
• Minimum 2 years of experience working in a customer service or healthcare environment
• Minimum 2 years of experience with data entry
• Demonstrated ability to work with confidential information and maintain strict confidentiality
• Proven ability to work effectively in a deadline-driven environment
• Excellent written and verbal communication skills
• Intermediate PC/computer skills
• Ability to work independently with minimal supervision
• Able to travel throughout the Des Moines metro area, reliable transportation required for local travel

Nice To Haves

• Experience in a health care environment
• Experience in Iowa Medicaid
• Experience in working remotely
• Satisfactory completion of medical terminology course

Responsibilities

• Interpret 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.
• Coordinate, distribute and track highly confidential medical information from multiple sources (fax, web, and phone).
• Interpret and adhere to URAC standards for assigned programs as well as federal and state requirements.
• Ensure quality customer service by responding to phone inquiries from members, physicians, and providers.
• Prioritize workload to meet program or regulatory time frames.
• Provide verbal and written communications of review decisions to include administrative denials.
• Complete service/treatment screens for accurate transmission of outcome decision.
• Provide general office support and perform miscellaneous duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED