Description:
GENERAL SUMMARY
Under the direct supervision of clinical staff, performs assigned duties including telephonic or fax screening of requests for authorization of services, contacting provider offices with follow-up information, verifying patient eligibility, and performing data entry of authorizations or denials for members into appropriate database. Performs other administrative functions in the Utilization Department as assigned.
ESSENTIAL RESPONSIBILITIES
- Performs telephonic support for member services including, but not limited to, entering pertinent demographic information obtained from the caller based on departmental policies, verifying patient eligibility, and communicating referral numbers to the caller. Screens fax requests for services; enters appropriate information into the database.
- Provides direct support to providers regarding utilization, authorization, and referral activities. Contacts providers with authorization, denial, and appeals process information.
- Assists in gathering information to support the Concurrent Review Coordinators.
- Provides data entry support for authorizations or denials for members in an in-patient setting, rehabilitation facility, or a skilled nursing facility.
- Assists in educating and acts as a resource to provider offices and facilities.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous experience (2 years) in a general office environment preferred.
- Proficient with ICD-9, CPT, and HCPCS coding.
- Familiarity with medical terminology (or willingness to take a medical terminology course) required.
- Excellent communication skills required.
- Ability to use standard corporate software packages and corporate applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Office/Clerical
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-04-30 00:00:00.0
Job ID: 1311604
GENERAL SUMMARY
Under the direct supervision of clinical staff, performs assigned duties including telephonic or fax screening of requests for authorization of services, contacting provider offices with follow-up information, verifying patient eligibility, and performing data entry of authorizations or denials for members into appropriate database. Performs other administrative functions in the Utilization Department as assigned.
ESSENTIAL RESPONSIBILITIES
- Performs telephonic support for member services including, but not limited to, entering pertinent demographic information obtained from the caller based on departmental policies, verifying patient eligibility, and communicating referral numbers to the caller. Screens fax requests for services; enters appropriate information into the database.
- Provides direct support to providers regarding utilization, authorization, and referral activities. Contacts providers with authorization, denial, and appeals process information.
- Assists in gathering information to support the Concurrent Review Coordinators.
- Provides data entry support for authorizations or denials for members in an in-patient setting, rehabilitation facility, or a skilled nursing facility.
- Assists in educating and acts as a resource to provider offices and facilities.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous experience (2 years) in a general office environment preferred.
- Proficient with ICD-9, CPT, and HCPCS coding.
- Familiarity with medical terminology (or willingness to take a medical terminology course) required.
- Excellent communication skills required.
- Ability to use standard corporate software packages and corporate applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Office/Clerical
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-04-30 00:00:00.0
Job ID: 1311604