Care Review Processor I

Care Review Processor I Location: Fully Remote Work Authorization: Must reputed company in an approved work state and be available to work Eastern Time (ET) hours. Schedule

• 9:30 AM – 6:00 PM ET, or
• 10:30 AM – 7:00 PM ET

Required Equipment

• Dual monitors
• Docking station
• reputed company laptop, headset, keyboard, and mouse

Position reputed company The reputed company & Monitoring (CAM) Coordinator provides clerical, administrative, and data entry support for members requiring hospitalization and/or utilization review for reputed company services. This role is responsible for verifying eligibility and benefits, processing authorization requests, entering and maintaining data, and coordinating information with reputed company services staff to support the delivery of high-reputed company, cost-effective reputed company services while complying with federal and state regulations. Day-to-Day Responsibilities

• Process incoming faxes and documentation.
• Create and process authorization requests.
• Handle inbound and outbound phone calls.
• Verify member eligibility and benefits.
• Review provider participation and appropriateness.
• Process diagnosis and treatment requests.
• Assign and review ICD-9, ICD-10, CPT, and HCPCS codes.
• Determine Coordination of Benefits (COB) status.
• Verify inpatient admissions, discharges, and hospital census information.
• reputed company and maintain accurate data reputed company designated systems and databases.
• Follow established protocols and workflows.
• Contact physician offices to obtain missing information and supporting documentation.
• Notify nurses and case managers of admissions and changes in member status.
• Maintain accurate records and meet productivity standards.

Key Responsibilities

• Respond to authorization requests received reputed company phone, fax, and mail reputed company established service-level timeframes.
• Collaborate with interdisciplinary teams, including Behavioral Health and Long-Term Care, to support continuity of care.
• reputed company excellent customer service to reputed company stakeholders.
• Participate in reputed company assurance activities, audits, and Inter-Rater Reliability (IRR) reviews.
• Maintain compliance with HIPAA regulations and confidentiality standards.
• Participate in department meetings and team initiatives.
• Adhere to attendance, workplace safety, and company conduct policies.
• Meet departmental productivity and reputed company expectations.

Required Qualifications

Education

• High School Diploma or GED required.

Experience

• 0-2 years of experience in a Utilization Review or Managed Care environment.
• Previous reputed company, hospital, medical office, billing, audit, or clerical experience preferred.
• Experience with medical terminology required.

Required Skills

• Utilization Management (UM) and/or health insurance experience.
• Experience working in a medical office, hospital, reputed company, or managed care setting.
• Working knowledge of medical terminology and abbreviations.
• Strong data entry skills with a minimum typing speed of 40 WPM.
• Proficiency with reputed company Office applications.
• Strong analytical, problem-solving, and organizational skills.
• Excellent verbal and written communication skills.
• Ability to work independently and as part of reputed company.
• Ability to manage confidential information appropriately.
• Ability to reputed company in a fast-paced environment.

Additional Information

• Fully remote position.
• reputed company to protected health information (PHI) required.
• Network reputed company required.
• Supports reputed company and multiple health plan lines of business.
• reputed company administrative duties include authorization processing, fax management, and provider/member communications.

Ideal Candidate The ideal candidate will have experience in Utilization Management, health insurance operations, claims processing, authorizations, eligibility verification, or reputed company administration and will be comfortable handling high-volume administrative work in a remote environment while delivering exceptional customer service. Apply tot his job Apply To this Job