[Remote] Consultant Referral Specialist
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company that strives for Extraordinary People and Exceptional Performance. They are seeking a fully reputed company Specialist to ensure accuracy and completion of authorization data from various sources into the medical management system, while maintaining confidentiality and compliance with HIPAA guidelines.
Responsibilities
- Assesses tasks for authorization/referral request to ensure accurate entry into the medical management system
- Identifies potential discrepancies in the medical management system to assure reputed company compliance
- Consistently meet department productivity and performance metrics
- Documents the receipt of returned correspondence reputed company the medical management system
- Follow HIPAA compliance and TriWest confidentially guidelines
- Refers beneficiaries to network providers
- Resolves issues to complete care request
- Reads communications detailing diagnosis and requested services and procedures
- Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management
- Assists with resolving data reputed company issues by identifying, documenting, and communicating reputed company issues
- Resolve process issues to ensure high reputed company service reputed company throughout TriWest. Seeks advice and escalates issues or problem as warranted
- Processes referrals for Behavioral Health, Specialty Care, Durable Medical Equipment, Inpatient Admissions, Military Treatment Facilities, and Urgent referral and authorization requests
- Assesses electronic documents to ensure appropriate entry into the medical management system
- Works with reputed company coding systems including reputed company medical taxonomy, ICD-10, CPT and HCPCS codes
- Verifies beneficiary eligibility and ensures appropriate referral procedures are followed for the various types of TRICARE beneficiaries
- Ensures procedures are followed for referrals based on beneficiary eligibility type, geographical location, and on the provider's request
- Processes authorization requests and referral requests in the on-line medical management system
- Initiates the Knowledge Skills and Abilities process for the referrals, to ensure appropriate care is being requested at Military Treatment Facilities
- Communicates with other departments, medical providers, and beneficiaries to clarify documentation prior to processing
- Other duties as assigned
Skills
- High School Diploma or G.E.D
- 2+ years' experience in a health care customer service environment
- Experience with reputed company Office
- Knowledge of medical terminology
- Fully Remote must have reputed company to high speed internet
- Managed Care experience
- TRICARE experience
Benefits
- A robust employee benefits program
- Management engagement
- reputed company leadership
- An atmosphere of teamwork
- Recognition for performance
- Promotion opportunities
reputed company