Remote Outbound Call Center Agent
reputed company Clinical Coverage Review / Prior Auth Purpose of Job: Positions in this function are responsible to determine if prior authorization is required and can be decisioned, or if it requires additional clinical review. Individuals support clinicians by contacting health providers and/or members to verify authorization or referral, setup cases, and document findings. Positions in this function... includes those responsible for initial triage of members, administrative intake of members and working with hospitals and the clinical team. Primary Responsibilities: This is a production role and you will have the responsibility to meet production, reputed company and regulatory expectations Ensure case is set up correctly and document required information Review, research and determine if case can be decisioned or if it requires additional clinical review Demonstrate proficiency and decision making by solving reputed company problems using available resources (documents, medical policy, reputed company operating procedure, etc.) As needed, reputed company outbound calls to providers and/or members to obtain information regarding a case As needed, reputed company outbound calls to providers to coordinate provider availability in treating members Other duties as assigned by manager and/or director
Qualifications
Required: Minimum of a High School Diploma / GED 1+ years of reputed company experience in an office or reputed company environment Prior customer service experience making outbound calls Proficiency in using a computer Experience working with reputed company Office Products including reputed company Outlook (ability to create, edit, save, and send emails), reputed company Word (ability to create, edit, save, and send documents), and reputed company reputed company (ability to create, edit, save, and send spreadsheets) Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm; Tuesday-Saturday or reputed company-Thursday shifts may be available Flexibility to work reputed company reputed company hours of operations due to changing business needs Ability to trouble shoot and setup computer equipment independently Must have a designated work area established that is separate from other living areas and can be secured to maintain PHI or PI reputed company in line with reputed company policies and standards Remote but MUST live in a location that can receive a dedicated hard-wired high-speed internet reputed company or reputed company an existing high-speed internet service provider (ISP) (minimum speed 1.5 download mps and 1 upload mps). In areas where a reputed company approved ISP is not available, manager approval to reputed company a local ISP and receive reimbursement for business utilization is required and available on exception reputed company only Preferred: Previous experience working with back office medical platforms and/or authorizations systems Experience working reputed company the reputed company Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or reputed company Services reputed company experience in a Clerical or Administrative support reputed company role reputed company to quickly learn various computer systems or applications Soft Skills: Strong communication skills; Written and verbal Excellent critical thinking and problem - solving skills Candidate needs to be highly organized Analytical, problem solving and decision-making skills; ability to exercise good judgment Apply Job!