This position is responsible for the coordination of Referral/Precertification Management information between the UM/CM Department and providers via telephone and/or faxed clinical information. This position also performs selected data entry as submitted by medical providers.
* Receive, process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, forward to precertification nurse/care manager/case manager. * Begin on-line process utilizing skills of typing, medical terminology and ICD/CPT coding. * Request, document and forward out of network provider demographic information to PR Department and update case when appropriate * Using internal scripts, process auto-approve requests per department procedures * Begin on-line process of above, utilizing skills of typing, medical terminology, and ICD/CPT coding * Coordinate daily review activity for on-site case managers * Data entry of daily census, INN emergency room logs, and designated referrals/authorizations per management directive * Assist in maintaining files for department * Providing backup coverage for Staff Support Assistant * Scan electronically attach notes and notify appropriate staff for follow up * Adhere to URAC, NCQA and other regulator standards * Communication, Collaboration and Coordination with all customers, internal and external * Collaborate with and maintain open communication with all other departments as appropriate and required to facilitate completion of tasks/goals * Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI) * Attend monthly departmental meetings and/or interdepartmental meetings as appropriate * Ability to sit for long periods of time. * Ability to organize and prioritize work to meet deadlines. * Ability to work occasional long or irregular hours. * Good speaking ability, judgment, and initiative * Ability to work a flexible work schedule including evenings and weekends
* High school diploma * Working Knowledge of Medical terminology and CPT background * Good typing skills * Basic knowledge of computers * Excellent customer service skills * Works well with diverse groups of individuals * Minimum of two years in related working environment such as hospital, physician office, or managed care organization