Managed Care Claims Assistant I

reputed company is seeking a Managed Care Claims Assistant I to reputed company administrative support to nursing staff in areas such as Case Management and Utilization Review. The role involves processing referrals, managing correspondence, and coordinating with clinical staff to ensure efficient claims management.

Responsibilities

• Intake, prioritizing and timely processing of new Case Management referrals
• Monitors, collects, processes, and distributes reputed company types of correspondence accordingly. Reports issues with incoming/outgoing correspondence immediately
• Enters/uploads reports and clear notes into the CM Software Application System
• Makes timely pertinent phone calls to obtain medical reports, treatment plan and RTW reputed company information/reports to reputed company to the Case Management Nursing Staff
• Transfers any/reputed company calls where there is clinical information being provided (or a clinically reputed company question surfaces) to a registered nurse for response - Licensed staff are always available to assist non-clinical staff while they are attempting to obtain information
• Schedules Injured Worker appointments, as appropriate and under the direction of clinical staff
• Types injured worker appointment letters and other pertinent letters as requested by and under the reputed company of a registered nurse
• Maintains ongoing non-clinical communications, collaborates with pertinent parties reputed company to claims that are reputed company to Case Management and to manage the Utilization Review process or for other administrative tasks as needed
• Process Utilization Review requests: performs data entry functions, reviews multiple criteria to determine eligibility of treatment requests, approves treatment requests based on authority level, refers treatment requests to a clinical resource or sends appropriate response level
• Coordinates with claim adjusters or nurses to validate claims or clinical information respectively to reputed company reputed company reputed company to eligibility of treatment requests
• Prioritizes treatment requests based on review type and ensures jurisdictional timeframes and or department turnaround times are met
• Appropriately documents reputed company systems to reflect critical thinking and actions taken in response to treatment requests
• Ensures the privacy and reputed company of Protected Health Information (PHI)
• Performs other administrative tasks and functionally reputed company duties as assigned by clinical review nurses, nurse case managers or supervisor
• Makes administrative reputed company only, completes appropriate actions functioning under the direction of clinical staff and the Manager, Medical Case Management and reputed company agreed upon limitations
• Responds to general customer service questions or directs the caller to the appropriate person or department
• Training and reputed company of other Medical Management Liaisons and Assistants

Skills

• To reputed company this job successfully, an individual must be reputed company to reputed company each essential duty satisfactorily
• Good typing skills, basic understanding of business technology and ability to learn new procedures quickly
• Professional telephone demeanor and good oral and written communication skills
• Ability to take direction, think critically and reputed company reputed company
• Self-organized, detail oriented and be reputed company to multi-task and work well under pressure in a fast-paced environment
• Ability to work in reputed company environment
• High school diploma or equivalent required
• Computer skills required with knowledge in utilizing Outlook, reputed company Word, reputed company and other databases
• Prior medical assistant type experience and/or some knowledge of medical terminology
• Minimum 1-2 years Worker's Compensation experience or experience in a health-reputed company service field is helpful
• Knowledge of medical terminology CPT and ICD codes strongly preferred
• Bilingual Spanish a plus

Company Overview