Works within the Healthcare Services (HCS) team to provide clerical and data entry support for members that require hospitalization and/or utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate HCSs staff to ensure the delivery of integrated high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Members. Also supports the HCS team by providing telephonic outreach and assessment for members through programs designed to improve health outcomes and maintain wellness. Works collaboratively with the HCS team to reach members and provide them with wellness and condition management programs designed to improve clinical, financial and quality of life outcomes.
MINIMUM EDUCATION: High School Diploma or GED
MINIMUM EXPERIENCE: Proficient Computer Skills
PREFERRED EXPERIENCE: One year or more in a Utilization Review Department in a Managed Care Environment. Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical Terminology.
PREFERRED CERTIFICATIONS/LICENSURE: Certification in Coding, auditing or billing