Career Center

Summary:

This position is responsible for the coordination of Referral/Precertification Management information between Utilization Management and providers via telephone and/or faxed clinical information and for data entry of Utilization Management information as submitted by on-site Case Managers and/or 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 Clerical Support staff
• Adhere to URAC 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

Requirements:

• High school diploma
• Medical Terminology including procedure and diagnoses codes knowledge
• Able to adapt in a fast-paced workplace
• Referral/Authorization processes knowledge
• 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

Work Type: 

Full Time