Review Assistant

Telligen

11d

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. Essential Functions You will 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. You will coordinate, distribute and tracks highly confidential medical information from multiple sources (fax, web, and phone). You will interpret and adhere to URAC standards for assigned programs as well as federal and state requirements. You will escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members. You will ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames. You will provide verbal and written communications of review decisions to include administrative denials. Complete service/treatment screens for accurate transmission of outcome decision. You will effectively guide members to appropriate member benefit information. You will provide general office support and performs miscellaneous duties as assigned. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and weâre seeking talented individuals who share our passion and are ready to take ownership, make an impact and helth shape the future of health. Are you Ready? Weâre on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success. Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are. Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives. Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen! Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

Requirements

High school diploma or equivalent
2 years of experience working in a customer service or healthcare environment
Demonstrate 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
Medical terminology experience preferred

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 tracks 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
escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members
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
effectively guide members to appropriate member benefit information
provide general office support and performs miscellaneous duties as assigned