Offer summary

Qualifications:

High school graduate with college or university experience., Knowledge of medical terminology and a medical background is required., Strong understanding of health insurance processes, including claims management and prior authorization., Customer service experience is essential. .

Key responsibilities:

Engage with providers over the phone for inbound and outbound communication.

Process provider requests and compliance inquiries as needed.

Accurately enter documentation into Care Advance and assign faxes to designated staff.

Collaborate with team members, including peers and nurses, to provide high-quality service.

Job description

Department: Commercial Inpatient Pr

Will this position be required to work onsite for any reason at any time? No, completely remote

Engagement Description –
Work Hours:
• Schedule: Full-time, 40 hours per week
• Hours: Monday through Friday, 8:00 AM to 5:00 PM
• Flexibility: Schedules will include some Saturdays, Sundays, and Holidays; overtime may be necessary

Top 3 Required Skills/Experience –
• Medical terminology knowledge or a medical background is required
• Customer service experience is required
• High school graduate and college or university experience

Required Skills/Experience – The rest of the required skills/experience. Include:
• Strong understanding of health insurance processes, including claims management, benefits coordination, and prior authorization

Preferred Skills/Experience – Optional but preferred skills/experience. Include:
• Two years of college or associate level degree equivalent
• Experience with providing high quality, provider focused servicing to facilities and doctors
• Work collaboratively as a team member with peers and nurses
• Concisely and accurately enter documentation into Care Advance
• Effectively engage over the phone via both inbound and outbound with providers
• Process provider requests as needed
• Acts as providers first trusted source for UM Prior Auth programs
• Assign faxes to designated staff
• Process requests for compliance inquiries
• Access various UM department mailboxes and voicemail as needed
• Ability to function independently
• Critical Thinking

• Education/Certifications – Include: High school graduate and college or university experience

Required profile