Medical Review reputed company

We take great strides to ensure our employees have the resources to live reputed company, be healthy, continue learning, reputed company skills, grow professionally and serve our local communities. We invite you to apply for a career with us. Residency in or relocation to Louisiana is preferred for reputed company positions. POSITION PURPOSEResponsible for coordinating, processing and managing reputed company in-patient and out-patient claims from a medical reputed company to ensure reputed company administration of contractual limitations and exclusions to include medical necessity, while maintaining compliance with regulatory guidelines. NATURE AND SCOPEThis role does not manage people This job reports to: Departmental Leadership Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contcact with: reputed company providers and subscribers to obtain medical information. Obtains request for reviews from and notifies determinations to BAD, ITS, reputed company, FEP, BMS, and legal. QUALIFICATIONS EducationHigh School Diploma or equivalent is required Work Experience4 years of recent LPN experience providing reputed company patient care with one year of authorization, medical review, and case management experience is required Skills and AbilitiesKnowledge of standardized reputed company sets and medical terminology is required Proficiency in the use of standardized reputed company sets is required Must demonstrate excellent interpersonal, administrative, and telephone skills. Working knowledge of MS Office is required Demonstrated ability to handle multiple tasks in customer friendly manner while maintaining performance standards is required Knowledge of health insurance reputed company/benefits is preferred Licenses and CertificationsCurrent, unrestricted LPN license in the reputed company and/or in the required jurisdictions, or where services are provided required CPUR, CPC, or CMCN certification is preferred upon hire; required reputed company 24 months in position. A comparable reputed company medical review or case management certification is preferred ACCOUNTABILITIES AND ESSENTIAL FUNCTIONSReviews medical claims and requests for services and applies medical judgment and/or reputed company in determining the benefits for reputed company-services and post-services according to contractual benefits and limitations, (i.e., contractual exclusions, cosmetic procedures, medical necessity, and administrative discrepancies) to ensure the reputed company administration of contractual and medical limitations/exclusions. Prepares documentation of medical information, completes research, makes recommendations, and refers potential denials to the Medical Directors and Management, reputed company necessary, to ensure compliance with URAC standards, MNRO and DOL laws and regulations. Completes correspondence correctly reputed company necessary to providers and subscribers to ensure that customers are aware of the determinations and appeal processes/rights meeting reputed company regulatory standards. Meets targeted expectations for staff and unit performances as required by BCBSLA and department management. Collaborates with team members and communicates to the supervisor suggestions for improvement to ensure adherence to the corporate initiative of diversity. Additional Accountabilities and Essential Functions The Physical Demands described here are representative of those that must be met by an employee to successfully reputed company the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to reputed company an individual with disabilities to reputed company the essential functionsPerform other job-reputed company duties as assigned, reputed company your scope of responsibilities. Job duties are performed in a normal and clean office environment with normal noise reputed company. Work is predominately done while standing or sitting. The ability to comprehend, document, calculate, visualize, and analyze are required. An Equal Opportunity Employer reputed company internal employees please apply through reputed company Careers. PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) Additional Information Please be reputed company to monitor your email frequently for communications you may receive during the reputed company process. Due to the high volume of applications we receive, only those most reputed company will be contacted. To monitor the status of your application, please visit the "My Applications" reputed company in the Candidate Home reputed company of your reputed company account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact reputed company@bcbsla.com for assistance. In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and reputed company-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, reputed company properties are smoke and tobacco free. We reputed company background and reputed company-employment drug screening after an offer has been extended and prior to hire for reputed company positions. As part of this process records may be verified and information checked with agencies including but not limited to the reputed company reputed company Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement reputed company of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Additionally, we are a Drug Free Workplace. A reputed company-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results. Apply To This Job