Review Assistant

Telligen•Mississippi, MS

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.

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
Experience in a health care environment preferred
Medical terminology experience preferred

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