??**** Must be willing to work 9 am to 6 pm PST ***** Full-time positions only at this time. Job description: Administrative and data entry role for the Utilization Review and Peer Review Department for Workers??Compensation, Group Health & Disability; verifies and enters data in appropriate system(s); and provides general support to clinical staff, reviewing physicians, claims adjusters, and others in a team environment. ESSENTIAL FUNCTIONS and RESPONSIBILITIES ??Uploading referral forms ??Entering new referral data ??Verifying client requirements ??Coordinating with nurses, physicians and clients ??Assigning new referrals and completing referral procedures ??Assigning, triaging and monitoring cases for utilization review (UR) ??Responding to communications from providers, claims adjusters, patients, and others ??Placing outbound telephone calls to providers to schedule and facilitate review discussions ??Entering demographics and other information into claims or clinical management system and maintaining data integrity ??Obtaining all necessary information required for utilization review processing and case management from internal and external sources per policies and procedures ??Distributing incoming and outgoing correspondence, faxes, and mail; uploading review documents into paperless system as necessary ??General data entry, general data retrieval, general document and information retrieval, general business communication ??Participating in audits, accreditation, and other quality assurance functions ??Performing all job functions according to the related policies, procedures, instructions, laws, and regulations promulgated by the appropriate authority or the company ??Running reports ??Attending or assisting in training ??Supporting other units as needed ??Performing other duties as assigned ??Supporting the organization's quality program(s) QUALIFICATIONS: High school diploma or equivalent. Physical Activity ??Requires extended periods of sitting, phone work and data entry Position Requirements ??High school diploma required, AA or BA degree preferred ??Possesses excellent customer service skills ??Ability to plan daily schedule and demonstrate good organizational skills ??Professional and effective communication skills, both verbal and written ??Competency in Microsoft Office, Excel, online database systems, and keyboarding ??Ability to work independently, analyze information and problem solve ??Good teamwork, organizational, decision making, and management skills ??Capable of multitasking and meeting timeframes ??Must be able to handle sensitive and confidential information with the highest degree of professionalism Preferred Skills and Qualifications ??Previous professional experience in the medical field, healthcare, insurance claims, Workers??Compensation, managed care, medical management, and/or utilization review ??Medical terminology ??Bill review experience ??**** Must be willing to work 9 am to 6 pm PST ***** Job Type: Full-time Schedule: ??Monday to Friday Application Question(s): ??Can you work 9 am PST to 6 pm PST? Shift availability: ??Day Shift (Preferred) Work Location: Remote
Apply Now