Industry: Private
Employment Type:- Full Time
Work Hours:- 8 Hours
Locations:- USA
Full Job Description:-
Job Description:
- Conducts non clinical reviews based on applicable criteria and guidelines on requested services. Communicates decision to provider and/or member, according to department protocols.
- Documents outcome of reviews and demonstrates the ability to interpret and analyze the non-clinical information.
- Completes verbal or non verbal outreach to providers or members to obtain the medical information for the review.
- Identifies and refers organization determinations that require a clinical review to a nurse or Medical Director.
- Conducts reviews of authorizations entered to ensure accuracy to avoid impacting claims payment.
- Supports the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards.
- Supports the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing.
- Serves as a subject matter expert for CM&O around the non-clinical review process.
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Hiring Requirements
- High school diploma or GED
- 3+ years of experience in related field.
Company Description
Select Source International (SSI) is an IT, Health Care, and Engineering Services consulting firm that has been in business since 1998. SSI consultants have provided exceptional services that have been appreciated by clients, customers, and users alike at several large Fortune 500 companies, mid-size enterprises, and consulting companies.
